Infectious Sacroiliitis: A Radiographic No Touch Lesion

Malhotra, Ashwin; Kalil, Ramsey; Jones, Ryan M.; Schwartz, Danielle; Qadeer, Asem H; Huang, Mingqian; Abdullah, Robert

doi:10.4172/2329-9126.1000336

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…The diagnosis of infectious sacroiliitis is often delayed due to the heterogeneous clinical presentations, lack of specific symptoms, low sensitivity of clinical tests, and initial normal appearing radiographs. 14 Most patients present with lumbo-gluteal pain; fever is a symptom only in about 35%-41% of them. 15 Delayed diagnosis results in complications, such as abscesses, sequestration, joint destruction, disseminated infection, sepsis, and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In most clinical settings, the crucial differentiation is between infectious sacroiliitis and spondyloarthritis. The diagnosis of infectious sacroiliitis is often delayed due to the heterogeneous clinical presentations, lack of specific symptoms, low sensitivity of clinical tests, and initial normal appearing radiographs 14 . Most patients present with lumbo‐gluteal pain; fever is a symptom only in about 35%–41% of them 15 .…”

Section: Discussionmentioning

confidence: 99%

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MRI predictors of infectious etiology in patients with unilateral sacroiliitis

Kandagaddala,

Sathyakumar,

Mathew

et al. 2024

Int J of Rheum Dis

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BackgroundUnilateral presentation of sacroiliitis is a diagnostic dilemma, especially between infection and inflammatory sacroiliitis associated with spondyloarthritis, requiring an early and accurate diagnosis.ObjectiveTo assess the utility of magnetic resonance imaging (MRI) in differentiating infective versus inflammatory etiology in unilateral sacroiliitis.Materials and MethodsRetrospective review of the MRI of 90 patients with unilateral sacroiliitis, having an established final diagnosis. MR images were evaluated for various bone and soft tissue changes using predefined criteria and analyzed using univariate and multivariate regression analysis.ResultsAmong the 90 patients, infective etiology was diagnosed in 66 (73.3%) and inflammatory etiology in 24 (26.7%). Large erosions, both iliac and sacral‐sided edema, joint space involvement with effusion or synovitis, soft tissue edema, elevated ESR/CRP, and absence of capsulitis and enthesitis were associated with infection (p < .001). The independently differentiating variables favoring infection on multivariate analysis were—both iliac and sacral‐sided edema (OR 4.79, 95% CI: 0.96–23.81, p = .05), large erosions (OR 17.96, 95% CI: 2.66–121.02, p = .003), and joint space involvement (OR 9.9, 95% CI: 1.36–72.06, p = .02). Exclusive features of infection were osteomyelitis, sequestra, abscesses, sinus tracts, large erosions, and multifocality. All infective cases had soft tissue edema, joint space involvement, elevated ESR, and no capsulitis.ConclusionMRI evaluation for the presence and pattern of bone and joint space involvement, soft tissue involvement, and careful attention to certain exclusive features will aid in differentiating infectious sacroiliitis from inflammatory sacroiliitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MRI predictors of infectious etiology in patients with unilateral sacroiliitis

Kandagaddala,

Sathyakumar,

Mathew

et al. 2024

Int J of Rheum Dis

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“…The underlying pathophysiology of ISI is thought to involve hematogenous spread of bacteria or local extension of adjacent soft tissue or bone infection. The most common isolated culprit is S. aureus; however, other bacteria can be identified as well such as Salmonella, Streptococcus, Brucella, Mycobacterium tuberculosis and Pseudomonas [5].…”

Section: Discussionmentioning

confidence: 99%

The Contribution of SPECT/CT Bone Scintigraphy in the Localization of an Infective (Purulent) Sacroiliitis – A Case Report

Manevska

Popovski

Makazlieva

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: Infectious sacroiliitis (ISI) is an inflammation of one or both of the sacroiliac (SI) joints, relatively rare disorder, affecting between 1% and 2% of all patients with septic arthritis. The variety of symptom presentation makes the diagnosis quite challenging. Combination of laboratory hematological tests, together with diagnostic imaging tools, such as magnetic resonance imaging (MRI), computed tomography (CT), and bone scan (BS), as well as microbiological tests contribute the final diagnosis, which may take up to several months. CASE REPORT: We present a case of a 33-year-old male patient with a history of lower back pain with propagation of the pain in the right leg, accompanied by febrility and hematuria. Laboratory tests showed high values of C-reactive protein, high degradation products and hyperkalemia, leading to a diagnose of acute renal failure stage 3. MRI of the lower spine and pelvis revealed hetero- signal change more to the right where the spinal canal was expanded, accumulating contrast and involved the caudate and the right radix. Тhe displayed sequences were accompanied by an altered morphology of the spinal musculature, with intense accumulation of contrast in parts of the muscle. Paravertebral abscess was detected in the intercaudal and iliac muscles, along with inflammatory edema of the right SI with a suspicion of a sacroiliitis. One week after, a three phase BS showed positive accumulation in the right SI joint in all three phases. The SI index for the right SI joint was 2.09, while for the left SI joint was 1.125. The patient underwent surgical intervention for drainage of the paravertebral abscess. CONCLUSION: The condition of ISI may be sometimes very difficult to be recognized in many patients. Considering the diversity of the clinical manifestations, it is of great importance to select the right imaging modality. The nuclear medicine technique triple phase bone and the hybrid imaging SPECT/CT have been suggested to improve the sensitivity and specificity of the bone scan, providing better characterization of equivocal lesions, especially in the acute form for disease localization.

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Infectious Sacroiliitis: A Radiographic No Touch Lesion

Cited by 2 publications

References 11 publications

MRI predictors of infectious etiology in patients with unilateral sacroiliitis

MRI predictors of infectious etiology in patients with unilateral sacroiliitis

The Contribution of SPECT/CT Bone Scintigraphy in the Localization of an Infective (Purulent) Sacroiliitis – A Case Report

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