What's the Diagnosis? - Case 5

History 52-year-old woman with low back pain.

What’s the Diagnosis - Case 5

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What’s the Diagnosis - Case 5

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Findings Sagittal sequences demonstrate syndesmophyte formation along the anterior vertebral column. There is also increased signal in the lower intervertebral discs on the T1 and T2 sequences which in this situation corresponds to calcification of the disc. Coronal sequence demonstrates fusion of the sacroiliac joints and the axial sequence demonstrates dural ectasia and thecal diverticula.

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Diagnosis: Ankylosing Spondylitis Seronegative arthropathy that produces syndesmophytes (ossification of the annulus fibrosus) that start at the thoracolumbar junction and extend cranially and caudally, sacroilitis with eventual fusion, and enthesopathic change. In cases of marked disease and later in the time course dural ectasia may become manifest with associated cauda equina syndrome.

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Supplemental radiographs demonstrate syndesmophyte formation of the cervical spine as well as osseous bridging of the facet joints. Single view of the left knee demonstrates enthesopathic change along the course of the MCL.

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Resources • Resnick and Kransdorf. Bone and Joint Imaging. 2005.

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http://www.ncbi.nlm.nih.gov/pubmed/17332972?dopt=AbstractPlus

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http://www.rheumatology.org

Further Reading • Hospital for Special Surgery Manual of Rheumatology and Outpatient Orthopedic Disorders, Ch. 39 - Ankylosing Spondylitis Sign up for our monthly eNewsletter to find out when a new case will be posted.

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