Ankylosing spondylitis signs

Case contributed by Dr Dinesh Brand

Presentation

Nocturnal back pain and history of autoimmune disease. Query ankylosing spondylitis.

Patient Data

Age: 30 years
Gender: Female
X-ray

There is evidence of thoracic vertebral endplate irregularity from T7 to T10.
There is suspicion of vertebral body squaring.
There appears to be a healing response to inflammatory endplate erosions with reactive sclerosis, the so-called "shiny corner" sign.
There is suspicion of Romanus lesions of vertebral end plates suggestive of the differential diagnosis of ankylosing spondylitis.

CT

There is evidence of irregularity and erosion involving the anterior and posterior edges of the vertebral endplates suggestive of Romanus lesions.
There is suspicion of a healing response to inflammatory endplate erosions with reactive sclerosis, the so-called "shiny corner" sign.
There is vertebral body squaring in the lower thoracic spine.

Case Discussion

Endplate irregularities were seen in the lower thoracic spine on X-ray and the patient proceeded to have a limited view CT which was requested by the referring medical practitioner.

The Romanus lesion represents an early healing response in inflammatory spondyloarthropathies such as ankylosing spondylitis and enteropathic arthritis.

Reactive sclerosis due to a healing response is the named the "shiny corner" sign.

The presence of vertebral body squaring may also be seen in:- Paget's disease of bone; rheumatoid arthritis; (RA); Reiter syndrome; psoriatic arthritis; and juvenile idiopathic arthritis.

An MRI spine was recommended as it would be more sensitive than X-ray and CT in showing inflammatory changes such as bone marrow edema.

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Case information

rID: 67282
Published: 29th Mar 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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