Ankylosing spondylitis (bilateral sacroiliitis and romanus lesion)

Case contributed by Dr Alexander Ortiz


Presents with history of chronic low back pain without incident trauma.

Patient Data

Age: 36 years
Gender: Male

An active Romanus lesion is seen on the anterior vertebral edge of L2 depicted as reduced signal intensity on T1WI images and increased signal intensity on STIR images representing bone marrow edema. There is another small Romanus lesion seen on the inferior portion of the posterior vertebral edge of T11. Signs of bilateral sacroiliitis are also seen and are depicted as increased signal intensity on coronal STIR images seen predominantly on the left sacroiliac joint indicating an active inflammatory lesion. The right sacroiliac joint better represents a chronic inflammatory lesion depicted as areas of low signal intensity on STIR and T1WI images consistent with subchondral sclerosis with associated erosion seen as a reduced intensity bony defect of the iliac portion of the sacroiliac joint on coronal STIR images. 

Case Discussion

The patient is a male who presents with history of chronic low back pain with an onset of symptoms before the age of 40 years and MRI findings that depict bilateral sacroilitis with associated active inflammatory lesions at the vertebral edges in the thoracolumbar region consistent with ankylosing spondylitis.

Case courtesy of Dr Guillermo Bolivar

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