Presentation
Bilateral chronic hip and gluteal pain.
Patient Data
Bilateral arthropathic changes of the hip and sacroiliac joints showing subchondral marrow degenerative marrow edema signal and pseudocystic changes, evident on the acetabular articular surfaces.
Marrow edema within the greater trochanters on both sides, with gluteus medius and minimus peritendinous edema, impressive for gluteal enthesitis.
Case Discussion
The combined features of sacroiliac and hip arthropathy as well as gluteal enthesitis was suggestive of seronegative arthropathy. Diagnosis was confirmed by elevated C-reactive protein and positive HLA-B27 gene test.
Seronegative spondyloarthritis is associated with synovitis, spondylitis (spinal inflammation), dactylitis (sausage digit), and enthesitis (inflammation of the ligament, tendon, or capsule bone
insertion).
Enthesitis is characterized by bone marrow edema and perienthesis soft tissue edema.
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