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PubMed2004

Xanthoma of the sacrum.

Xanthoma is a lesion containing abundant foamy histiocytes most commonly occurring in superficial soft tissues such as skin, subcutis, or tendon sheaths. The involvement of deep skeletal structures, however, is rare and has only been infrequently reported in the English literature. Most xanthomas occur in patients with hyperlipidemic disorders. We report a case of a xanthoma in the sacrum and ilium of a patient with hyperlipidemia type IIa, who had chronic lower back pain for more than 20 years. On radiographs the lesion appeared multiloculated and osteolytic with a thin sclerotic border and containing multiple nodular calcifications within its matrix. Computed tomographic images revealed a presacral soft-tissue mass that also infiltrated the adjacent sacroiliac joint and iliac fossa. On histologic examination, abundant areas of xanthoma cells and cholesterol clefts, typical of xanthoma, were present. The patient received simple curettage of the lesion, and his symptoms were markedly relieved.

Diagnosis, Differential↗
PubMed1980

Scintigraphic evidence of transient unilateral sacroiliitis in a case of Whipple's disease.

Investigation of low back pain by quantitative sacroiliac joint scintigraphy (QSS) can detect the presence of sacroiliitis not apparent by roentgenography. Transient unilateral sacroiliitis was documented by QSS in a patient with Whipple's disease during tetracycline treatment, when the peripheral arthropathy was in remission. Thus, the pattern of inflammatory spinal disease, if associated with the intestinal disease, differs from that of the peripheral arthritis.

Arthritis↗
PubMed1990

Differential diagnosis between osteitis condensans ilii and sacroiliitis.

Sacroiliitis of seronegative spondyloarthropathy may sometimes show on pelvis plain films findings indistinguishable from those of osteitis condensans ilii. Computed tomography (CT) can differentiate earlier than plain radiography between the 2 conditions; furthermore, it should also be possible to make this differentiation clinically. The aim of our study was to verify whether the criteria recently proposed by the European Spondylarthropathy Study Group (EESG) for the classification of spondyloarthropathy are useful. CT scans through the synovial part of the sacroiliac joints of 7 consecutive patients meeting the ESSG criteria and showing typical findings of osteitis condensans ilii on plain films were mixed with those of 15 consecutive patients with osteitis condensans ilii not meeting the ESSG criteria. Scans were examined for joint space and surface abnormalities blindly and independently by 2 observers. Six patients in the spondyloarthropathy group and one in the osteiitis condensans ilii group showed clear erosions and/or joint space narrowing of less than 2 mm in at least one joint. The difference was statistically significant (p less than 0.001). Our results suggest that by using criteria valid for the whole group of seronegative spondyloarthropathies, it is possible to differentiate clinically between seronegative spondyloarthropathies with sacroiliitis mimicking osteitis condensans ilii and "true" osteitis condensans ilii.

Adult↗
PubMed2003

Tuberculous sacroiliitis: a case report.

Tuberculosis can affect sacroiliac joints, but only a few such cases have been reported. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. We report herein a culture-proven case of tuberculous sacroiliitis which initially mimicked neoplastic infiltration on CT scan.

Abscess↗
PubMedDate not supplied

[X-ray diagnosis of injuries to the posterior part of the pelvic ring in children].

Proceeding from morphoroentgenological investigation of 48 isolated pelvic specimens from dead children, a new method for radiodiagnosis of fractures of lateral sacral masses (LSM) and rupture of sacroiliac joints (SIJ), based on quantitative assessment of pelvic ring deformity has been developed. Limitations of the method were established. The introduction of this roentgenometric method into clinical practice for diagnosis of injury of the posterior pelvic semiring permitted an increase in x-ray detection of LSM fractures 10-fold and SIJ ruptures 2.5-fold.

Child↗
PubMedDate not supplied

Acute sacroiliitis as a manifestation of calcium pyrophosphate dihydrate crystal deposition disease.

While radiographic lesions of the sacroiliac joint (SIJ) are common in patients with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, they are rarely accompanied by clinical symptoms. We report the case of a 69-year-old woman who presented with an acute sacoiliitis and a linear calcification in the right SIJ on CT scan. The patient recovered well after intra-articular steroid injections.

Acute Disease↗
PubMedDate not supplied

Scintiscanning in ankylosing spondylitis: a clinical, radiological and quantitative radioisotopic study.

Twenty-six patients with ankylosing spondylitis and 10 control subjects had quantitative dorso-lumbar and sacroiliac scintigraphy performed using 99mtechnetium methylene diphosphonate. No difference was found in the mean uptakes of radionucleide at each vertebral level or in the sacroiliac joints between the diseases patients and controls. No correlation was found between radionucleide uptake and radiological score, pain and tenderness assessments. The large variation in quantiative measurements resulted in a large overlap between control and diseased patients and it is unlikely that scintigraphy will be of diagnostic value in the absence of improved methodology.

Adolescent↗
PubMed1980

Sacroiliitis in women--a late sequela to acute salpingitis.

Fifty-seven women who were treated for severe acute salpingitis between June, 1974, and June, 1976, were examined in 1978, 24 to 48 months after their first hospitalization. At the same time, 31 healthy women matched for age and parity were examined. All patients and control subjects were examined independently by a gynecologist and a rheumatologist. Forty-two of the patients and all control subjects were examined by quantitative 99mTc-pertechnetate scanning of the sacroiliac joints. These same joints also were examined by x-ray in the 57 patients. Sacroiliitis was documented in 39 of the 57 salpingitis patients (68%) and in one of the control subjects (3%), a difference which was statistically significant. There was no difference between the two groups in the presence of histocompatibility antigen HLA B27. The findings strongly suggest a correlation between severe acute salpingitis and sacroiliitis in women.

Adult↗
PubMed1983

Clinical aspects of juvenile and adult ankylosing spondylitis.

Ankylosing spondylitis (AS) is a heterogeneous and systemic rheumatic disorder that is characterized primarily by inflammation of the spine and sacroiliac joints. Consequently, back pain is a frequent presenting complaint although the disease can begin with peripheral arthritis as well as acute anterior uveitis. Unlike men, however, women appear to have milder or atypical AS that may go unrecognized for years. Moreover, the presentation in children rests on the recognition of two distinct subgroups that may be indistinguishable from juvenile chronic polyarthritis. The more frequent subgroup includes primarily teenage boys who present initially with an asymmetric peripheral pauciarthritis that most often affects lower-limb joints. Only some years later does sacroiliitis evolve, and, much later still, back complaints or other clinical and radiographic features typical of AS. A second subgroup includes mostly girls with a polyarticular onset that is subsequently characterized by cervical fusion, micrognathia, acute anterior uveitis, sacroiliitis, spondylitis, and rheumatoid-like hands that persist into adulthood.

Adolescent↗
PubMedDate not supplied

Applications of bone scintigraphy in ankylosing spondylitis.

Eighteen bone scintisans performed in 14 patients with ankylosing spondylitis were reviewed. In young patients with low back pain, positive serology, and indeterminate radiographs, quantitative sacroiliac joint assessment and the presence of typical uptake patterns, particularly costovertebral, were useful in suggesting the diagnosis. Scintigraphy was helpful in the early detection of pseudoarthrosis complicating long-standing disease, especially in patients presenting with recurrent back pain. Selective application of bone scintigraphy aids the diagnosis of ankylosing spondylitis and its potential complications.

Adolescent↗
PubMed1993

Pyogenic sacroiliitis in Qatar.

We describe our experience in handling six cases of pyogenic sacroiliitis. Two were males and four were females with a mean age of 24.9 years. None had a history of i.v. drug abuse. Blood cultures were positive in half of the patients. The sacroiliac joint aspirate was positive in one additional patient. Staphylococcus aureus was recovered from three of four culture positive cases. Bone and CT scans revealed abnormalities in all patients. Response to antibiotic therapy was satisfactory in all except one patient who had an early relapse. Early diagnoses and proper treatment would result in improved outcomes.

Adolescent↗
PubMed1997

Pneumococcal sacroiliitis.

We report an unusual case of Streptococcus pneumoniae sacroiliitis in a previously healthy 31-year-old woman. Six cases of pneumococcal sacroiliitis have been reported; the only two cases in adults occurred in young women in the preantibiotic era. Our patient had fever and a depressed level of consciousness, with subsequent right buttock and thigh pain. Blood cultures revealed S pneumoniae, and a bone scan showed increased tracer activity in the right sacroiliac joint. Although the cerebrospinal fluid white blood cell count was only 3/microL, culture of cerebrospinal fluid grew S pneumoniae. Our patient was successfully treated with a 6-week course of intravenous antibiotics (penicillin G after an initial week of ceftriaxone), followed by 2 weeks of oral penicillin therapy.

Administration, Oral↗
PubMed2002

[Salmonella virchow sacroiliitis and bacteremia in a child].

A 2.5 years old girl was admitted because of high fever and limping that appeared two days after she had trauma to her right leg. Bone scan demonstrated increased uptake in the right sacroiliac joint, and CT demonstrated right sacroiliitis. Salmonella vircow was isolated from the blood culture. The patient recovered after a five weeks course of intravenous antibiotics. Salmonella sacroiliitis in children is rare, and only seven cases have been reported in the English literature in the last 40 years. We reviewed the literature dealing with pathophysiology diagnosis therapy and outcome of this infection.

Anti-Bacterial Agents↗
PubMed1977

The sacroiliitis of acute Reiter's syndrome.

Sacroiliitis can be demonstrated radiologically in over one-third of patients with chronic Reiter's syndrome. We have used a bone scan technique with digital analysis which will quantitatively assess the sacroiliac joints, and have found abnormalities in 24 of 33 patients with active Reiter's syndrome. It seems likely therefore that sacroiliitis is a common feature in patients with early Reiter's syndrome and while in most patients it resolves with resolution of disease activity, in some it may persist with the development of overt radiological changes.

Acute Disease↗
PubMed1983

Observer variation in skeletal radiology.

The factors that affect observer variation in bone radiology are analysed from data in the literature and on the basis of studies carried out at McMaster University on the hands and sacroiliac joints. A plea is made for presenting results in terms of Kappa statistics so that agreement due purely to chance is eliminated. In the conclusions the main variables that affect concordance are listed so that strategies can be developed to reduce observer variation. This is important in serial studies to ensure that the observer variations are smaller than the effect one wishes to measure.

Age Determination by Skeleton↗
PubMed1984

Roentgenological features of ankylosing spondylitis. A comparison between patients attending hospital and cases selected through an epidemiological survey.

A roentgenological comparison between 105 hospital cases (HOSP AS) of ankylosing spondylitis and 27 cases selected through an epidemiological survey (EPI AS) was performed. The male HOSP AS patients exhibited more severe X-ray changes in the sacroiliac joints as compared to male EPI AS patients. The female HOSP AS patients more frequently exhibited lumbar X-ray changes typical of AS when compared to the female EPI AS patients. The main impression from the findings were that more severe and extensive radiological features were present in the AS cases selected through the Department of Rheumatology than in the cases present in the general population.

Adult↗
PubMed2000

Radiological changes of the symphysis in ankylosing spondylitis.

PURPOSE: To evaluate the symphyseal changes in patients with ankylosing spondylitis. MATERIAL AND METHODS: Radiological-morphological changes of the symphysis were studied in 68 patients (66 men, 2 women) with ankylosing spondylitis whose age ranged from 21 to 75 years. The duration of the disease was from 2 to 50 years. RESULTS AND CONCLUSION: Changes in the symphysis were found in 16 patients (23.5%) and were less prominent than findings in the sacroiliac joints. We classified these changes into four stages: minimal changes, apparent destruction, reparation and ankylosis. The third and the fourth stages of the changes in the symphsis were found more frequently in patients who suffered from the disease for more than 15 years. Radiological evaluation of symphyseal changes can be helpful in the evaluation of disease progression as well as in establishing a differential diagnosis.

Adult↗
PubMed1988

Source of error in clinical assessment of innominate rotation. A special communication.

The sacroiliac joint (SIJ) is a possible source of low back pain or dysfunction. Various methods of visually assessing the relative position of the innominate to the sacrum have been used to evaluate SIJ dysfunction. The purpose of this special communication is to describe how a false-positive interpretation of innominate rotation may occur when a leg-length difference exists and visual assessment is used.

Adult↗