The H-Shaped Vertebra on MRI: A Clue to Previously Undiagnosed Chronic Hemolytic Anemia

Abstract

Background: H-shaped (Lincoln log) vertebrae are a radiologic hallmark of chronic hemolytic anemia, often associated with sickle cell disease, resulting from repeated central endplate infarctions and may be an initial clue to undiagnosed systemic hematologic disorders. Aims: To highlight the characteristic MRI appearance of the H-shaped vertebra as a diagnostic clue to previously unrecognized chronic hemolytic anemia. Study Design: Case report. Presentation of Case: A 27-year-old man presented with chronic low back pain without known hematologic disease. Lumbar MRI demonstrated symmetric central depression of the vertebral endplates producing the characteristic H-shaped configuration. Diffuse low marrow signal intensity was observed on both T1- and T2-weighted sequences, consistent with marrow reconversion and fibrosis. Subsequent laboratory evaluation confirmed regenerative normocytic anemia related to chronic hemolytic anemia. Discussion: The H-shaped vertebra is a characteristic imaging finding most commonly associated with sickle cell disease and other chronic hemolytic disorders. Recognition of its symmetric multilevel endplate depression and associated marrow signal abnormalities may help differentiate it from vertebral compression deformities and degenerative endplate changes. Conclusion: Recognition of the characteristic MRI appearance of the H-shaped vertebra may facilitate early diagnosis of underlying hematologic disease and prevent diagnostic confusion with vertebral deformities.