Learning objectives
To help recognise the MR imaging features of acute septic unilateral sacroiliitis affecting either the synovial or ligamentous portions of the sacroiliac joint ;(Marrow oedema,
joint effusion,
juxta-articular soft tissue oedema+/- collections) .
To demonstrate ultrasound and CT guided aspiration techniques which are essential in the diagnostic work-upand management .
To increase awareness of uncommon causative organisms (Gram +ve cocci,
Mycobacterium tuberculosis and Brucella) and the utility of serological testing in addition to appropriate clinical history .
To avoid the pitfall of injudicious use of...
Background
Imaging of the sacroiliac joints is a unifying diagnostic tool for seronegative spondyloarthritis which includes plain radiographs as well as MR imaging.
The ASAS (Assessment of Spondyloarthritis International Society)diagnostic criteria for MR features of sacroiliitis is defined as focal high bone marrow signal intensity on the STIR / fat-suppressedT2-weighted images or contrast enhancement on the fat-suppressed T1-weightedimages.
The bone marrow edema is typically symmetrical in ankylosing spondylitis within the subchondral/peri-articular bone and most commonly affects the lower and posterior thirds of the joints,
usually commencing...
Findings and procedure details
We present a case-series of four patients who presented to our hospitals (3 in Romford,
UK and one in Abu Dhabi,
UAE) as worsening lower back /RIGHT hip pain with rapid deterioration of mobility:
Case 1: A 13 year old girl presented with right sided unilteral sacroiliitis with effusion and a small anterior subiliacus collection on the MRI study with restricted diffusion.
An ultrasound guided aspiration was performed yielding 10 mL of thick purulent material.
The microbiology culture grew Staphylococcus aureus and patient was treated...
Conclusion
Acute unilateral sacroiliitis should always raise suspicious for the possibility of septic arthritis particularly solitary involvement of the ligamentous portion as well as in the presence of adjacent soft tissue oedema or juxta-articular collections.
Radiological suspicion should dictate further management with image-guided aspiration or serological testing (in cases of tuberculosis or brucellosis).
Any corticosteroid intra-articular injection should be avoided until this suspicion is clearly refuted.
Personal information
Asad Rabbani Shah FRCR
Consultant Musculoskeletal Radiologist
Barking,
Havering & Redbridge University Hospitals NHS Trust,
Romford.
United Kingdom.
Shaikh Khalifa Medical City,
Seha Health Authority.
Abu Dhabi.
United Arab Emirates.
Harish Nagraj FRCR
Consultant Musculoskeletal Radiologist
Barking,
Havering & Redbridge University Hospitals NHS Trust,
Romford.
United Kingdom.
Shazia Abdullah FRCP
Consultant Rheumatologist
Shaikh Khalifa Medical City,
Seha Health Authority.
Abu Dhabi.
United Arab Emirates.
References
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Leone A.,
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Computed tomography and MR imaging in Spondyloarthritis.
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5....