Images in Paediatrics
Recurrent musculoskeletal pain and hemoglobin SC disease
Dolor musculoesquelético de repetición y hemoglobinopatía SC
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Corte sagital ponderado en densidad protónica con supresión grasa que muestra áreas heterogéneas hiperintensas en médula ósea y tejidos blandos de la región anterior de la tibia, debido a edema y cambios inflamatorios.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ara C. Almécija Muñoz, Estefanía Barral Mena, Miguel Rasero Ponferrada, María Baro Fernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ara C." 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The lesion seemed to extend to the sternal ossification centres and the cartilage of the right costochondral junctions, with low Doppler flow values.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gonzalo Fuente-Lucas, Marina Cecilia Planells-Alduvin, Paloma Tallón-Guerola, Pedro Alcalá-Minagorre" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Gonzalo" "apellidos" => "Fuente-Lucas" ] 1 => array:2 [ "nombre" => "Marina Cecilia" "apellidos" => "Planells-Alduvin" ] 2 => array:2 [ "nombre" => "Paloma" "apellidos" => "Tallón-Guerola" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Alcalá-Minagorre" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403320301922" "doi" => "10.1016/j.anpedi.2020.04.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403320301922?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287924000875?idApp=UINPBA00005H" "url" => "/23412879/0000010000000004/v1_202404250845/S2341287924000875/v1_202404250845/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287924001030" "issn" => "23412879" "doi" => "10.1016/j.anpede.2024.03.046" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "3589" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2024;100:309-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Paediatrics</span>" "titulo" => "Autoimmune pancreatitis: A diagnostic and therapeutic challenge" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "309" "paginaFinal" => "310" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pancreatitis autoinmune: un reto diagnóstico y terapéutico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 412 "Ancho" => 1007 "Tamanyo" => 115738 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histological examination of the pancreas. 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Almécija Muñoz, Estefanía Barral Mena, Miguel Rasero Ponferrada, María Baro Fernández" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ara C." "apellidos" => "Almécija Muñoz" "email" => array:1 [ 0 => "ara.almecija@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Estefanía" "apellidos" => "Barral Mena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Miguel" "apellidos" => "Rasero Ponferrada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "María" "apellidos" => "Baro Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Hemato-Oncología Pediátrica, Hospital Universitario Doce de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Reumatología Pediátrica, Hospital Universitario Doce de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0015" ] 2 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Doce de Octubre, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dolor musculoesquelético de repetición y hemoglobinopatía SC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1449 "Ancho" => 1250 "Tamanyo" => 109651 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI of the lower extremity. Coronal T1-weighted fat saturated post-gadolinium image showing an irregular geographic area of no enhancement in the proximal metaphysis and diaphysis of the tibia due to a large bone infarct.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a girl aged 6 years presenting with increasingly severe tibial pain and lameness of 10 days’ duration in the absence of fever or recent trauma. Both the patient and her mother had a previous diagnosis of hemoglobin (Hb) C trait, while her father had received a diagnosis of sickle cell trait. The patient reported having experienced several episodes of bone pain in different locations of her upper and lower extremities in the last year. The physical examination revealed pain in the right proximal tibial metaphysis on palpation, with no other relevant findings. Blood tests showed elevation of C-reactive protein (7.9<span class="elsevierStyleHsp" style=""></span>mg/dL), lactate dehydrogenase (420<span class="elsevierStyleHsp" style=""></span>mg/dL) and bilirubin (1.4<span class="elsevierStyleHsp" style=""></span>mg/dL), while the results of the complete blood count, coagulation tests and other biochemical tests were all normal. The findings of plain radiography were unremarkable, so bone scintigraphy was performed on the suspicion of chronic nonbacterial osteomyelitis based on the previous history of recurrent episodes of musculoskeletal pain. Since scintigraphy only revealed abnormal uptake at the tibial metaphysis, the decision was made to perform an MRI scan, which revealed an extensive acute bone infarct (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). This led to repetition of hemoglobin electrophoresis, which detected percentages of 46% of hemoglobin S and 44.5% of hemoglobin C, confirming the diagnosis of hemoglobin SC disease.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Hemoglobin SC disease, a compound heterozygous condition that manifests as the addition of sickle cell trait and HbC trait,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> neither of which has significant manifestations in isolation, results in serious disease because HbC increases the intracellular concentration of hemoglobin through loss of water, amplifying the effect of the 50% of HbS contained by increasing its tendency to polymerize.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Hemoglobin SC disease should not be considered a mild form of sickle cell disease, but a separate disease characterized by increased blood viscosity and a higher risk of thrombotic events.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1422 "Ancho" => 918 "Tamanyo" => 111438 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI of the lower extremity. Sagittal proton density-weighted fat saturated image shows heterogeneous hyperintensity of the bone marrow and soft tissues in the anterior part of the tibia due to edema and inflammatory changes.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1449 "Ancho" => 1250 "Tamanyo" => 109651 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI of the lower extremity. Coronal T1-weighted fat saturated post-gadolinium image showing an irregular geographic area of no enhancement in the proximal metaphysis and diaphysis of the tibia due to a large bone infarct.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemoglobinopathies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Lanzkowsky" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:7 [ "edicion" => "5th ed." "titulo" => "Manual of pediatric hematology and oncology" "fecha" => "2011" "paginaInicial" => "200" "paginaFinal" => "231" "editorial" => "Elsevier" "editorialLocalizacion" => "San Diego" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The paradox of hemoglobin SC disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.L. Nagel" 1 => "M.E. Fabry" 2 => "M.H. Steinberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0268-960X(03)00003-I" "Revista" => array:6 [ "tituloSerie" => "Blood Rev" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "167" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12818227" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000010000000004/v1_202404250845/S2341287918302114/v1_202404250845/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000010000000004/v1_202404250845/S2341287918302114/v1_202404250845/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918302114?idApp=UINPBA00005H" ]
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