0:00

So I'll end with a couple of, um, just problem cases that

0:05

actually kind of exemplify reasons why they're removing the

0:09

term reactive art osteitis out

0:12

of the lexicon In the description

0:14

of musculoskeletal infections, this is a 29-year-old man

0:18

who had a history of IBD presenting with great toe pain.

0:21

Radiographically, we see this diffuse soft tissue swelling

0:24

of the, almost the entirety

0:25

of the great toe from the metatarsal head to the, um,

0:29

to the distal failings.

0:31

And we looked at this

0:33

and, you know, with that history it

0:35

was really, really telling.

0:37

So we said, Hey, this is osteomyelitis.

0:39

But if we took a step back further, we could actually see

0:43

that there's actually additional, um, teno synovitis

0:47

of the X extensor and also flexor tendons.

0:50

The plot thickens in this particular patient in

0:52

that he also has uveitis

0:55

and UR from a prior OC infection.

0:59

And this is a, an example of reactive arthritis in a, uh,

1:04

29-year-old man.

1:06

And this next patient is another case of reactive arthritis

1:10

and of, again, proving the point, oh, sorry,

1:13

it was chlamydia, not gonorrhea, uh, another patient

1:17

who had a nail infection after a trip to the Philippines.

1:20

So on the MR images here we can see some thickening

1:24

and signal alteration of the nail.

1:26

And underlying that nail,

1:27

we have homogeneous signal alteration of the distal failings

1:31

and portions of the, uh, proximal PHAs

1:34

with marrow signal alteration on our T one weighted

1:38

sequences, but more homogeneous signal alteration

1:42

of the entirety of the proximal PHAs.

1:44

And this was another, uh, an example

1:47

of psoriatic arthro arthritis involving the great toe.

1:51

And so as we look over time from July through September,

1:55

we can see the progression

1:57

of this whiskering peros titis involving the distal failings

2:00

of the great toe, uh, compatible with, uh, the

2:04

Osteitis related to psoriasis.

2:08

And then sometimes we're gonna have some

2:09

challenge cases as well.

2:11

And so when we look at the marrow signal abnormality here,

2:15

it looks a little bit odd.

2:16

So this is a T one weighted sequence on the left

2:19

and our T two weighted sequence on the right.

2:21

So we have homogeneous low signal intensity on

2:23

our T one weighted sequence.

2:25

So, and homogeneous high signal intensity on our

2:30

T two weighted sequence.

2:31

So is the whole foot involved?

2:33

Uh, is the, is the entire, is the entire foot osteolytic?

2:38

And it is not, and this is not a technical error as well.

2:43

So this is an example of serious atrophy due

2:46

to a poor nutritional state.

2:48

The pathophysiology of this is in completely understood,

2:52

but it is thought to be related to the abnormal deposition

2:55

of hyaluronic acid, uh, rich muco pal

2:59

Polysaccharides in the bone marrow stroma

3:01

after lipolysis occurs.

3:03

So it's typically in the very late stages

3:06

of starvation that this occurs.

3:07

So it's the bone marrow is gonna be the last part

3:10

of our bodies to lose that fat.

3:13

So it went a little bit over with that little, um, uh,

3:17

snafu with PowerScribe.

3:19

Um, but I'll be around for questions later on.