What does a 'step-ladder' trabecular pattern on a radiograph indicate in a patient with sickle cell disease?

Correct answer: A. Coarse trabeculation from marrow hyperplasia compensating for chronic hemolytic anemia

• A. Correct. Sickle cell disease causes chronic hemolytic anemia → compensatory bone marrow hyperplasia to produce more RBCs. This enlarges marrow spaces, creating the coarse 'step-ladder' or 'hair-on-end' trabecular pattern visible on jaw radiographs. This is a pathognomonic radiographic finding.
• B. Incorrect. Osteomyelitis appears as diffuse ill-defined radiolucency and sclerosis — not a step-ladder pattern.
• C. Incorrect. Metastatic lesions appear moth-eaten or irregular — not as a regular step-ladder pattern.
• D. Incorrect. Multiple periapical abscesses appear as isolated radiolucencies — not a diffuse trabecular pattern.