PROBLEM
A 24-year-old man presents to your emergency department complaining of back pain. Based on these frontal and lateral projections of his spine, what is your diagnosis?

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ANSWER
This patient’s spinal appearance is typical for sickle cell disease, with a coarsened trabecular pattern to the bone, radiolucency, and characteristic H-shaped vertebral end plates. This altered contour is caused by the expansion of the intervertebral discs into the softened bone.

This series of diagnostic quizzes that challenge your ability to read a variety of x-ray films is edited by Dr. Keats, alumni professor of radiology at the University of Virginia School of Medicine in Charlottesville. Emerg Med 40(2):55-6, 2008