ankylosing spondylitis ( RID3604 )
So far as I can see in the EMR and previous imaging reports, there is no mention of Anklylosing Spondylitis, which is the diagnosis based on the findings. On Sag STIR there is bright signal in the T11-12 disc, with BME at the adjacent endplates and prevertebral edema, as well as marked edema in the region of the left > right costovertebral joints. Corresponding Sag PD images show multilevel syndesmophytes. Ax image at T8 shows fusion of costovertebral joints. In April, a neuro colleague read this a spondylodisciitis (with no mention of having reviewed prior XR or CT) deemed most suggestive of infection, with a documented call to the referrer (compare current images in Fig. 1 to 9 months ago in Fig. 3). The diagnosis should have, but was not made in pelvis XR and abd-pelv CT from 9 years ago, neither of which were reported by MSK radiologists. While the changes are striking on Sag STIR, I know that STIR imaging is not done routinely everywhere, and has not been routine in our facility. I imagine the findings would have been missed without it. The attached article (by OCADer WInston Rennie and friends) talks about the predilection for inflammatory spine changes at the periphery, cautioning one not to clip the margins of the vertebrae too closely so as not to miss them. [ Article ]
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