Ankylosing spondylitis complicated by fracture-dislocation

Case contributed by Azza Elgendy , 16 Jan 2015
Diagnosis certain
Changed by Henry Knipe, 8 Sep 2015

Updates to Case Attributes

Title was changed:
Ankylosing spondylitis complicated by fracture - dislocation-dislocation
Presentation was changed:
A known patient with ankylosing spondylitis who suffered minorMinor trauma that lead to back pain. The imaging was done 2 weeks after the trauma.
Age changed from 50 years old to 50 years.
Diagnostic Certainty was set to .

Tags changed:

  • rheumatology
  • trauma

Updates to Study Attributes

Modality was set to MRI.
Findings was added:

Hyperextension type of fracture that involve L4/L5 ossified and fused disc as well as the anterior syndesmophyte. There is T2 hyperintense signals involving the widened LV4/LV5 disc space most likely represent pseudarthrosis.  Abnormal marrow signal involving the superior and inferior end plates most likely represent bone marrow edema.
Images Changes:

Image MRI (T2) ( update )

Description was removed:
Sagittal T2 WI shows hyperextension type of fracture that involve LV4/LV5 ossified and fused disc as well as the anterior syndesmophyt . There is hyper hyperintense signals involving the widened LV4/LV5 disc space most likely represnt pseudoarthrosis . Abnormal marrow signals involving the superior and inferior end plates most likely represent bone marrow edema
Specifics changed from T2WI to T2.

Image MRI (T1) ( update )

Specifics changed from MRI T1WI to T1.
Description was removed:
T1WI ; The hypo hypointense marrow signals involve the LV4 & LV5 vertebral bodies most consistent with oedema .

Image MRI (STIR) ( update )

Specifics changed from STAIR to STIR.
Description was removed:
Sgittal stir shows the bright signals involving the widened LV4/LV5 disc space most likely due to pseudoarthrosis .

Image 1 MRI (T2) ( update )

Position was set to .

Image 3 MRI (STIR) ( update )

Position was set to .

Updates to Study Attributes

Modality was set to Annotated image.
Findings was added:

Shiny corner sign also known as Romanus sign.
Images Changes:

Image Annotated image (Sagittal CT bone window) ( update )

Perspective was set to Sagittal CT bone window.

Image 1 Annotated image (Sagittal CT bone window) ( create )

Updates to Study Attributes

Findings was changed:

ShinyAdvanced findings of ankylosing spondylitis manifested by multilevel vertebral body fusion, shiny corner signsigns, fused facet joints and bilateral sacroiliac joint fusion. Osteoporosis is also called Romanus signnoted.

Fracture dislocation is seen at L4/L5. The fracture line involves the L4/L5 disc space anteriorly and involves the pars interarticularis posteriorly. 

Images Changes:

Image CT (non-contrast) ( update )

Description was removed:
Bilateral sacro-iliac joint fusion

Image CT (non-contrast) ( update )

Description was removed:
Sagittal images illustrate advanced finding of Ankylosing manifested by multilevel vertebral body fusion, shiny corner signs , fused facet joints. Osteoporosis is also noted. Fracture dislocation is seen at LV4/LV5 . The farcture line involves the LV4/Lv5 disc space anteriorly and involve the pars interarticularis posteriorly

Image 2 CT (non-contrast) ( update )

Position was set to .

Updates to Quizquestion Attributes

Question was added:
What underlying condition do you suspect?
Answer was added:
Ankylosing spondylitis.

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