Sacroiliíte: avaliação por imagem

Montandon, Cristiano; Costa, Marlos Augusto Bitencourt; Carvalho, Tarcísio Nunes; Júnior, Marcelo Eustáquio Montandon; Teixeira, Kim-Ir-Sen Santos

doi:10.1590/s0100-39842007000100012

Cited by 14 publications

(7 citation statements)

References 11 publications

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“…In cases of trauma or inflammatory sacroiliitis, abnormalities such as bone incongruities, bone erosions, joint space alterations, subchondral sclerosis, and ankylosis can be seen on imaging such as computed tomography (CT) scans or even plain films. 14,15 Similarly, in cases of pelvic trauma, imaging can be diagnostic. However, radiographic findings are rarely helpful in the diagnosis of SIJ pain not related to an underlying rheumatologic condition or trauma.…”

Section: Diagnostic Imagingmentioning

confidence: 99%

Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review

Schneider

Rosati

Zheng

et al. 2019

PM&R

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Accurate diagnosis of sacroiliac joint (SIJ) pain is challenging. Diagnosis can be aided by pain referral patterns, historical features, physical examination maneuvers, and imaging. However, all of these diagnostic tools have limitations. The most reliable clinical tools may be a combination of three or more positive physical exam maneuvers, although the evidence is inconsistent even for this strategy. Intra‐articular diagnostic SIJ injections are often used as the reference standard for “true” sacroiliac pain. However, such injections do not consider extra‐articular sources of pain that may also exist as part of the sacroiliac joint complex. Research has established the posterior sacral ligaments as a possible source of pain, and the innervation of these ligaments has been anatomically defined. It is possible that by expanding our focus from the articular portion of the sacroiliac complex structure to both the joint and extra‐capsular ligaments, advancements in clinical diagnosis and treatment will be possible.

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Section: Diagnostic Imagingmentioning

confidence: 99%

Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review

Schneider

Rosati

Zheng

et al. 2019

PM&R

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“…The anterior-inferior portion of the SI joint, a true synovial joint, lies vertically oriented [4, 5]. The cartilage on the iliac side of the synovial part of the SI joint is thinner; thus, all SI disease processes involve the iliac side before the sacral side [5].…”

Section: Discussionmentioning

confidence: 99%

“…MRI findings during acute sacroiliitis include intra-articular fluid, subchondral bone marrow edema, articular and periarticular post-gadolinium enhancement, and soft tissue edema. Findings of chronic disease include periarticular bone marrow conversion, bone erosion, subchondral sclerosis and ankylosis [4]. Erosions are best demonstrated on T1- weighted fat-saturated sequences as high intensity signals.…”

Section: Discussionmentioning

confidence: 99%

Sacroiliitis mimics: a case report and review of the literature

Antonelli

Magrey

2017

BMC Musculoskelet Disord

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BackgroundRadiographic sacroiliitis is the hallmark of ankylosing spondylitis (AS), and detection of acute sacroiliitis is pivotal for early diagnosis of AS. Although radiographic sacroiliitis is a distinguishing feature of AS, sacroiliitis can be seen in a variety of other disease entities.Case presentationWe present an interesting case of sacroiliitis in a patient with Paget disease; the patient presented with inflammatory back pain which was treated with bisphosphonate. This case demonstrates comorbidity with Paget disease and possible ankylosing spondylitis. We also present a review of the literature for other cases of Paget involvement of the sacroiliac joint.ConclusionsIn addition, we review radiographic changes to the sacroiliac joint in classical ankylosing spondylitis as well as other common diseases. We compare and contrast features of other diseases that mimic sacroiliitis on a pelvic radiograph including Paget disease, osteitis condensans ilii, diffuse idiopathic skeletal hyperostosis, infections and sarcoid sacroiliitis. There are some features in the pelvic radiographic findings which help distinguish among mimics, however, one must also rely heavily on extra-pelvic radiographic lesions. In addition to the clinical presentation, various nuances may incline a clinician to the correct diagnosis; rheumatologists should be familiar with the imaging differences among these diseases and classic spondylitis findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1525-1) contains supplementary material, which is available to authorized users.

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“…[7][8][9][10] Even without any pathognomonic radiologic sign of TB SI, nuclear resonance showing subchondral bone marrow edema and irregularity of articular surface on an asymmetric distribution confirms unilateral SI. [11,12] Asymmetric SI without any other findings suggestive of spondiloarthropathy should be promptly investigated for infectious disease. [13] The chronic presentation of asymmetric SI pointed the clinical team in front of two possible infections: brucellosis and TB.…”

Section: Discussionmentioning

confidence: 99%

Sacroiliitis preceding disseminated pelvic and peritoneal tuberculosis

Carvalho¹,

Nunes

Moura

et al. 2016

CRCP

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Mycobacterium tuberculosis is the infectious agent responsible for tuberculosis (TB), one of the most common infectious causes of death in adults worldwide. It's protean manifestations may mimic different diseases in almost all clinical specialties. Herein we present a case of untreated tuberculosis sacroiliitis (SI) that evolved to disseminated pelvic disease mimicking ovarian carcinoma with peritoneal carcinomatosis. The patient complained of low back pain three years ago which was investigated with osseous scintigraphy and magnetic resonance imaging of the sacroiliac region and confirmed a left asymmetric SI. She was oriented to sporadically use of non-steroid anti-inflammatory drugs by the general physician who suspected spondiloarthropathy. Despite this, the symptoms got worse and progressed to abdominal pain, especially in hypogastric region, chronic diarrhea, severe night sweats, menstrual irregularity, weight loss, dyspareunia and undulant fever during the last year. She was admitted at this point and submitted to an exploratory video laparoscopic, the histopathology findings were strongly suggestive of disseminated pelvic TB showing granulomatous chronic inflammatory process with central caseous necrosis. The clinical team decided to initiate TB treatment, after 9 months of completed therapy, she was asymptomatic. The diagnosis of peritoneal tuberculosis usually is a challenge and invariably demands peritoneal biopsy. Mycobacterium tuberculosis can reach peritoneal tissue through the blood, lymphatic system and by contiguity. This case report presents an unusual form of pelvic and peritoneal disseminated tuberculosis preceded by a SI misdiagnosed as spondyloarthropathy.

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Sacroiliíte: avaliação por imagem

Cited by 14 publications

References 11 publications

Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review

Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review

Sacroiliitis mimics: a case report and review of the literature

Sacroiliitis preceding disseminated pelvic and peritoneal tuberculosis

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