This 29 year-old female patient presented with a chest infection, and a CXR was performed. The patient had a history of sickle-cell anaemia.
The lateral CXR shows multiple vertebral end-plate irregularities and depressions. The peripheral portions of the end-plates are spared. The appearance is due to bone infarction and subsequent collapse. This is an early example of the classical H-shaped vertebrae seen in sickle-cell anaemia.

H-shaped vertebrae are a characteristic finding seen in approximately 10% of patients with the disease. Bone infarction may be complicated by Salmonella osteomyelitis. Other signs to look for on chest films are cardiomegaly, absent spleen, and cholecystectomy clips.

Reference: Pope TL. Aunt Minnie’s Atlas & Imaging Specific Diagnosis. 2nd edition. Lippincott, Williams & Wilkins 2003

Credit: Dr Laughlin Dawes