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Interligator S, Le Bozec A, Cluzel G, Devilder M, Ghaouche J, Guenoun D, Fleury A, Petit Lemaire F, Carlier RY, Valente C, Creze M. Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation. Skeletal Radiol 2024; 53:2247-2262. [PMID: 38110777 DOI: 10.1007/s00256-023-04535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications MATERIALS AND METHODS: This retrospective study included patients with ISI who were evaluated between 2008 and 2021 in a single center. Two radiologists reviewed MRI and CT images to determine the anatomical distribution (unilateral/bilateral, iliac/sacral bone, proximal/middle/distal), severity (bone marrow edema [BME]/periostitis/erosions), concurrent infection (vertebral/nonvertebral), and complications (abscess/probable adjacent osteomyelitis/cavitation/devitalized areas/sequestrum/pelvic venous thrombosis) of ISI. Interobserver reproducibility was assessed. Correlation analysis evaluated the effect of the causative microorganism on severity. Two human bodies were dissected to outline possible ways that ISI can spread. RESULTS Forty patients with ISI (40 years ± 22; 26 women) were evaluated. Ten patients had bilateral ISI. Concurrent vertebral infection was associated in 15% of cases. Reproducibility of sacral BME, periostitis, and reactive locoregional abnormalities was perfect (κ = 1). Reproducibility was low for erosion count (κ = 0.52[0.52-0.82]) and periarticular osteopenia (κ = 0.50[0.18-0.82]). Inflammatory changes were BME (42/42 joints), muscle edema (38/42), and severe periostitis along the ilium (33/37). Destructive structural changes occurred with confluent erosions (iliac, 20/48; sacral, 13/48), sequestrum (20/48), and cavitation (12/48). Complications occurred in 75% of cases, including periarticular abscesses (n = 30/47), probable adjacent osteomyelitis (n = 16/37), and pelvic thrombophlebitis (n = 3). Tuberculous ISI (6/40) correlated with sclerosis (rs = 0.45[0.16; 0.67]; p < 10-2) and bone devitalization (rs = 0.38[0.16; 0.67]; p = .02). The anatomical study highlighted the shared venous vascularization of sacroiliac joints, pelvic organs, and mobile spine. CONCLUSION Complications of ISI are frequent, including abscesses, adjacent osteomyelitis, and periostitis. ISI had bilateral involvement nonrarely and is commonly associated with another spinal infection.
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Affiliation(s)
- Sarah Interligator
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Antoine Le Bozec
- Department of Pharmacy, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Guillaume Cluzel
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Matthieu Devilder
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Jessica Ghaouche
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Daphne Guenoun
- Department of Radiology, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Albane Fleury
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Florian Petit Lemaire
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Robert-Yves Carlier
- Department of Radiology, Hôpital Raymond Poincaré, Assistance-Publique des Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, 92380 Garches, Paris, France
| | - Catarina Valente
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Maud Creze
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France.
- Laboratoire d'Imagerie Biomedicale Multimodale Paris-Saclay, BioMaps, Paris-Saclay University, 4 place du Général Leclerc, 91401 Orsay, Paris, France.
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Lacroix M, Tordjman M, Bouchut A, Bordner A, Laporte A, Feydy A. Imaging of Sacroiliac Joints. Radiol Clin North Am 2024; 62:783-797. [PMID: 39059971 DOI: 10.1016/j.rcl.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
The central role of imaging in diagnosing disorders affecting the sacroiliac joints (SIJs) necessitates a comprehensive understanding of the advantages, limitations, and potential pitfalls of the imaging techniques that can be used. In this article, the anatomy and biomechanics of SIJs are exposed, outlining their unique features, particularly the division into anteroinferior cartilaginous and postero-superior ligamentous parts. Overall, the goal of this article is to offer a comprehensive understanding of imaging techniques, anatomic complexity, and diagnostic considerations relevant to SIJs disorders, facilitating accurate diagnosis and patient management in clinical practice and research.
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Affiliation(s)
- Maxime Lacroix
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France.
| | - Mickaël Tordjman
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Arthur Bouchut
- Department of Rheumatology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Adrien Bordner
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Amandine Laporte
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
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3
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Carotti M, Ceccarelli L, Poliseno AC, Ribichini F, Bandinelli F, Scarano E, Farah S, Di Carlo M, Giovagnoni A, Salaffi F. Imaging of Sacroiliac Pain: The Current State-of-the-Art. J Pers Med 2024; 14:873. [PMID: 39202065 PMCID: PMC11355172 DOI: 10.3390/jpm14080873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/03/2024] Open
Abstract
Pain in the sacroiliac (SI) region is a common clinical manifestation, often caused by diseases involving the SI joints. This is typically due to inflammation or degenerative changes, while infections or cancer are less frequent causes. The SI joint is challenging to image accurately because of its distinct anatomical characteristics. For an accurate diagnosis, conventional radiography often needs to be supplemented with more precise methods such as magnetic resonance imaging (MRI) or computed tomography (CT). Sacroiliitis, a common presenting feature of axial spondyloarthritis (axial SpA), manifests as bone marrow edema, erosions, sclerosis, and joint space narrowing. Septic sacroiliitis and repetitive stress injuries in sports can also cause changes resembling inflammatory sacroiliitis. Other conditions, such as osteitis condensans ilii (OCI), can mimic the radiologic characteristics of sacroiliitis. Inflammatory lesions are diagnosed by concurrent erosions, hyperostosis, and ankylosis. Ligament ossifications or mechanical stress can also result in arthritic disorders. Determining the exact diagnosis can be aided by the distribution of the lesions. Inflammatory lesions can affect any part of the articulation, including the inferior and posterior portions. Mechanical lesions, such as those seen in OCI, often occur in the anterior middle region of the joint. In cases of idiopathic skeletal hyperostosis, ligament ossification is found at the joint borders. This pictorial essay describes common SI joint problems, illustrated with multimodal imaging data. We, also, discuss strategies for selecting the best imaging modalities, along with imaging pitfalls, key points, and approaches for treating patients with suspected inflammatory back pain.
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Affiliation(s)
- Marina Carotti
- Clinica di Radiologia, Dipartimento di Scienze Radiologiche, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.C.); (A.C.P.); (F.R.); (A.G.)
| | - Luca Ceccarelli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy;
| | - Anna Claudia Poliseno
- Clinica di Radiologia, Dipartimento di Scienze Radiologiche, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.C.); (A.C.P.); (F.R.); (A.G.)
| | - Francesca Ribichini
- Clinica di Radiologia, Dipartimento di Scienze Radiologiche, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.C.); (A.C.P.); (F.R.); (A.G.)
| | - Francesca Bandinelli
- Rheumatology Department, San Giovanni di Dio Hospital, USL Tuscany Center, 50143 Florence, Italy;
| | - Enrico Scarano
- Department of Radiology, “San Carlo” Hospital, 85100 Potenza, Italy;
| | - Sonia Farah
- Rheumatology Unit, “Carlo Urbani” Hospital, Università Politecnica delle Marche, 60035 Jesi, Italy; (S.F.); (F.S.)
| | - Marco Di Carlo
- Rheumatology Unit, “Carlo Urbani” Hospital, Università Politecnica delle Marche, 60035 Jesi, Italy; (S.F.); (F.S.)
| | - Andrea Giovagnoni
- Clinica di Radiologia, Dipartimento di Scienze Radiologiche, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.C.); (A.C.P.); (F.R.); (A.G.)
| | - Fausto Salaffi
- Rheumatology Unit, “Carlo Urbani” Hospital, Università Politecnica delle Marche, 60035 Jesi, Italy; (S.F.); (F.S.)
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4
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Tokuyama Y, Yamada H, Shinozuka K, Yunoki T, Ohtsuru S. Pyogenic sacroiliitis caused by Salmonella schwarzengrund in a young healthy woman: a case report and literature review. Int J Emerg Med 2023; 16:21. [PMID: 36941606 PMCID: PMC10026423 DOI: 10.1186/s12245-023-00496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Salmonella species are a leading cause of diarrheal diseases worldwide. Recent epidemiological studies have shown that Salmonella schwarzengrund (S. schwarzengrund) is highly prevalent in various regions. Herein, we report that S. schwarzengrund caused sacroiliac joint (SIJ) infection with septic shock in a young woman, although she was immunocompetent. CASE PRESENTATION A 20-year-old woman presented with left hip pain, accompanied by vasopressor-requiring hypotension. Her imaging examinations showed fluid collection in her SIJ and a small abscess in the left iliac muscle. Later, the blood and aspiration fluid culture and genetic analysis revealed the presence of S. schwarzengrund. We diagnosed sacroiliac joint (SIJ) infection with septic shock caused by S. schwarzengrund. Her condition improved after performing several interventional radiology (IVR) procedures for SIJ abscesses and providing appropriate antibiotic treatment. Finally, she was discharged without any sequelae. Screening tests and genetic analysis about her immunodeficiency did not indicate a congenital disorder. CONCLUSION These clinical courses indicate that S. schwarzengrund could cause the fatal SIJ infection irrespective of the host immunocompetence. Considering the recent increase in the diagnostic rate of S. schwarzengrund, this case emphasized the need to be more cautious about Salmonella species infection.
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Affiliation(s)
- Yuki Tokuyama
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Yamada
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Shinozuka
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
| | - Tomoyuki Yunoki
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
| | - Shigeru Ohtsuru
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan.
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5
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Muacevic A, Adler JR, Razzak AN, Jha P, Ugolini C. Complex Case Management of Mycobacterium Tuberculosis Extrapulmonary Manifestation to the Right Sacroiliac Joint. Cureus 2023; 15:e33789. [PMID: 36819328 PMCID: PMC9928219 DOI: 10.7759/cureus.33789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/16/2023] Open
Abstract
While Mycobacterium tuberculosis is a common bacterial pathogen that infects the respiratory system, especially in endemic regions, it may uncommonly manifest in other organ systems, such as the nervous, gastrointestinal, or musculoskeletal systems. Sacroiliac joint infections are rare, and only 1%-5% of all infections are tuberculous in nature. Given nonspecific inflammatory signs in both laboratory and radiologic examinations, early identification of the causative agent can be difficult. In this report, we present the case of a 29-year-old Eritrean woman who presented with an uncommon extrapulmonary tuberculosis manifestation of the right sacroiliac joint. The patient reported pain for two years before a formal diagnosis with multiple computed tomography scans demonstrated fluid collections about her right hip and thigh. The patient's medical history of developmental delay, psychosis, outdated medication documentation, non-therapeutic use of numerous psychiatric medications contraindicated for traditional anti-tubercular therapy, and socioeconomic history of a lack of social support and treatment arrangements with the patient's caregiver all complicated the treatment course. Given the rise in tuberculosis cases worldwide and vulnerability factors in patients with mental illnesses such as poverty, homelessness, diabetes, and HIV infection that can predispose patients to tuberculosis infections, early diagnosis and treatment are essential to reduce long-term consequences and improve clinical outcomes. Further research in the development of new tuberculosis treatment plans is essential to addressing an equitable treatment course alongside fighting against the recent rise in drug-resistant tuberculosis.
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6
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Freije T, Patel F, Christenson J, Saysana M. Inability to Bear Weight and Fever in a 16-year-old Boy. Pediatr Rev 2022; 43:593-595. [PMID: 36180541 DOI: 10.1542/pir.2020-003152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Affiliation(s)
- Thomas Freije
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Feenalie Patel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - John Christenson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Michele Saysana
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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7
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Simon EL, Wainblat EG, Krizo JA, Smalley CM, Fertel BS. Septic Sacroiliitis caused by Serratia marcescens. Am J Emerg Med 2020; 38:2758.e5-2758.e8. [PMID: 32527605 DOI: 10.1016/j.ajem.2020.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Erin L Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA; Northeast Ohio Medical University, Rootstown, Ohio, USA.
| | - Ethan G Wainblat
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA; Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Jessica A Krizo
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA; Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Courtney M Smalley
- Cleveland Clinic Emergency Services Institute, Cleveland Clinic Lerner College of Medicine Cleveland, OH, USA
| | - Baruch S Fertel
- Emergency Services Institute Cleveland Clinic Foundation, Enterprise Quality and Safety, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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8
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Anton G, Tong D, Little T, Soo TM. Minimally Invasive Sacroiliac Joint Fusion for the Treatment of Brucella Pyogenic Sacroiliitis: A Case Report. Cureus 2019; 11:e6212. [PMID: 31890413 PMCID: PMC6925378 DOI: 10.7759/cureus.6212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 39-year-old male presented with a two-month history of right hip pain. Computed tomography (CT) scan demonstrated right sacroiliac joint space widening with cortical destruction and erosive changes in the iliopsoas muscle. Minimally invasive right sacroiliac joint fusion was performed with biopsy and aspirate, which confirmed positive Brucella cultures. The patient was started on long-term antibiotic therapy, and his pain significantly improved. Pyogenic sacroiliitis is a rare condition that requires a high index of suspicion. In this case, minimally invasive sacroiliac joint fusion successfully treated the patient’s pain and instability as well as aided in the diagnosis of Brucella infection.
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Affiliation(s)
- Gustavo Anton
- Neurosugery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| | - Doris Tong
- Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| | - Tania Little
- Infectious Disease, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| | - Teck M Soo
- Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
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Park SA, Kwak DS, Cho HJ. Technical variation of trans-articular sacroiliac joint (SIJ) fusion using three screws considering the effects of sacral dysplasia in patients with non-traumatic SIJ pain. BMC Musculoskelet Disord 2019; 20:386. [PMID: 31455346 PMCID: PMC6712884 DOI: 10.1186/s12891-019-2771-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 08/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluated the technical adequacy of trans-articular sacroiliac joint (SIJ) fusion using three screws for non-traumatic SIJ pain, considering different grades of sacral dysplasia. Methods Cadaveric CT data of unilateral sacropelvic complexes for 72 individuals (53.4 ± 8.4 years) were selected. A 3D model was reformatted into the plain lateral radiograph to mark the articular surface of the SIJ. Subjects were classified into dysplastic (DYS) and non-dysplastic sacrum (NDS) groups. Proximal (PS), middle (MS), and distal screws (DS) with 10-mm diameter were virtually introduced to the iliac bone and the SIJ on the lateral image with a 5-mm safety margin. On a corresponding axial image, each screw was advanced vertically to the sagittal plane with the same safety margin. The entry points for each screw to the endplate of S1 (S2) and to the corresponding anterior sacral margin on the lateral image were measured, along with the maximal screw lengths on the axial image. Whether each screw passed through the SIJ was determined. Different types of sacral dysplasia and screws were compared statistically. Results Thirty-eight (26.4%) cases were DYS, and 106 (73.6%) were NDS. The entry points of all screws were significantly more distal in DYS than in NDS groups. The PS and MS screw lengths differed significantly between the 2 groups. Incidences of short sacral fixation (< 10 mm) were significantly higher for the DS in both NDS (38.7%) and DYS (39.5%) groups. Incidences of screw pass were lowest for the MS in both NDS (43.4%) and DYS (47.4%) groups. Conclusions Sacral dysplasia locates the SIJ more distally and therefore affects the entry point locations and screw lengths for all screws in trans-articular SIJ fusion, compared with a non-dysplastic sacrum. Moreover, three-screw fixation risks the development of unstable DS fixation and a high extra-articular fixation rate in MS.
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Affiliation(s)
- Soo-An Park
- Department of Orthopedic Surgery, Chung General Hospital, 76 Sujeong-ro, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13316, South Korea
| | - Dai-Soon Kwak
- Catholic Institute of Applied Anatomy / Department of Anatomy, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
| | - Ho-Jung Cho
- Catholic Institute of Applied Anatomy / Department of Anatomy, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
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10
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Barnes M, Bush C, Jones J. Pyogenic sacroiliitis: A rare complication of inflammatory bowel disease. Am J Emerg Med 2019; 37:1395.e1-1395.e2. [PMID: 31005399 DOI: 10.1016/j.ajem.2019.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/06/2023] Open
Abstract
Although sacroiliitis is not uncommon in patients with inflammatory bowel diseases (IBD), bacterial infection of the sacroiliac joint is rare. The diagnosis is often delayed because of low clinical suspicion, a vague clinical picture and poorly defined localization of symptoms. We report a case of pyogenic sacroiliitis in a patient with Crohn's disease caused by Clostridia spp. and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness.
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Affiliation(s)
- Mariah Barnes
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States of America
| | - Colleen Bush
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States of America
| | - Jeffrey Jones
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States of America.
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11
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Chee YC, Lim CH. Klebsiella pneumoniae sacroiliac septic arthritis: First case report. IDCases 2018; 14:e00459. [PMID: 30386726 PMCID: PMC6205928 DOI: 10.1016/j.idcr.2018.e00459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 09/30/2018] [Accepted: 10/14/2018] [Indexed: 11/23/2022] Open
Abstract
Infective sacroiliitis is a rare disease with misleading clinical signs that often delay diagnosis. We report a case of pyogenic sacroiliac joint septic arthritis caused by Klebsiella pneumoniae that has not been reported in the literature highlighting its importance especially among diabetics.
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Affiliation(s)
- Yong Chuan Chee
- Department of Internal Medicine, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
- Corresponding author at: Hospital Sultanah Bahiyah, KM 6, Jalan Langgar, Alor Setar, Kedah, Malaysia.
| | - Chong Hong Lim
- Rheumatology Unit, Department of Internal Medicine, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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12
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Calle E, González LA, Muñoz CH, Jaramillo D, Vanegas A, Vásquez G. Tuberculous sacroiliitis in a patient with systemic lupus erythematosus: a case report and literature review. Lupus 2018. [DOI: 10.1177/0961203318762594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) patients are at higher risk of developing opportunistic infections such as tuberculosis (TB), especially extrapulmonary forms like osteoarticular TB, compared to the general population. However, tuberculous sacroiliitis has been scarcely reported in these patients. We present a 34-year-old woman with SLE who developed articular tuberculosis simultaneously affecting the right sacroiliac joint and the left knee. The patient was successfully treated with antituberculosis therapy for nine months. In this case, in addition to the immunological abnormalities of lupus, the long-term glucocorticoid therapy at high dosages was the main risk factor for the development of osteoarticular tuberculosis.
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Affiliation(s)
- E Calle
- División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - L A González
- División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - C H Muñoz
- División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - D Jaramillo
- División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - A Vanegas
- División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - G Vásquez
- División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Sección de Inmunogenética, Universidad de Antioquia, Medellín, Colombia
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Abstract
Septic arthritis is an inflammation of a joint caused directly by various microorganisms. It is often characterized by many unspecific symptoms. Bacteria is the most often etiological factor. We present a case report of a 76-years old woman with a unilateral septic arthritis of the sacroiliac joint. Bacterial sacroiliitis should be taken into account in patients with sacroiliitis and fever onset. Proper diagnosis can be very often difficult and delayed but fast implementation of antibiotic therapy is extremely important in the treatment process. Diagnostic imaging is crucial to the diagnosis and monitoring of septic arthritis. Magnetic resonance imaging is the most relevant tool for the detection of sacroiliitis, allowing the institution of therapeutic strategies to impede the progression of the disease.
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14
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Ghosh S, Narang H, Goel P, Kumar P, Soneja M, Biswas A. Atypical presentation of pyogenic iliopsoas abscess in two cases. Drug Discov Ther 2018; 12:47-50. [DOI: 10.5582/ddt.2018.01000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sudeshna Ghosh
- Department of Medicine, All India Institute of Medical Science
| | - Himanshu Narang
- Department of Medicine, All India Institute of Medical Science
| | - Pawan Goel
- Department of Medicine, All India Institute of Medical Science
| | - Prabhat Kumar
- Department of Medicine, All India Institute of Medical Science
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Science
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Science
| |
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