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Sacroiliitis

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<v ->So we'll end up now with the final segment

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of today's conference,

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and I'm gonna begin with the topic of sacroiliitis

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and to talk a bit about it

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and what it looks like in the spondyloarthropathies.

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So, as I already indicated to you in the last lecture

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that just about every disease that involves

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the sacroiliac joint begins on the ilial side

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and dominates on the ilial side,

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so here's a beautiful coronal section

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through that sacroiliac joint

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showing you extensive erosions involving the ilial side

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with only some minor erosions on the sacral side.

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This is what the earliest abnormalities look like

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with conventional radiography,

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an ill-defined margin to the sacroiliac joint,

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and in my experience,

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I tend to look at the inferior aspect of the joint

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for the earliest findings.

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So ilial predominance,

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bone erosions associated with bone sclerosis,

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initial bone widening and then subsequent narrowing,

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and in some cases, not all, intraarticular bone fusion.

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Now, when we say the sacroiliitis of ankylosing spondylitis

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is bilateral and symmetrical,

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you have to have a little bit of leeway.

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Here's an example of sacroiliitis involving both joints,

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clearly worse on one side than on the other side.

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This will not dissuade me from the diagnosis

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of ankylosing spondylitis.

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As long as it's bilateral and rather symmetrical,

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I'm gonna consider ankylosing spondylitis

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as the best diagnosis.

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But let me add that the sacroiliitis

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of inflammatory bowel disease,

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that's ulcerative colitis, Crohn's disease, looks the same.

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You also get sacroiliitis in Whipple's disease,

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but it can look a little bit different.

Report

Faculty

Donald Resnick, MD

Professor Emeritus, Department of Radiology

University of California, San Diego

Carlos H. Longo, MD

Head of Radiology

Hospital Beneficência Portuguesa de São Paulo

Abdalla Skaf, MD

Head of the Department of Diagnostic Imaging Hospital HCor / Medical director of ALTA diagnostics (DASA group)

HCOR / DASA / TELEIMAGEM

Rodrigo Aguiar, MD, PhD

Professor of Radiology

Federal University of Paraná - Brazil

Marcelo D’Abreu, MD

Head of Radiology

Hospital Mae de Deus

Tags

Musculoskeletal (MSK)

MSK

MRI

Hip & Thigh