VOL.13 NO.12 DECEMBER 2008
Radiology Quiz
Radiology Quiz
Dr. Wendy WM Lam
Consultant, Department of Radiology, Queen Mary Hospital
Clinical History:
Male/13
C/O joint pain
This is his XR hands.
Questions:
1. What are the radiological findings?
2. What is your diagnosis or DDX?
Answer to Radiology Quiz
Radiological Findings:
1. Generalized decreased in bone density, particularly at peri-articular region.
2. Narrowing of bilateral DIP & PIP joint spaces.
3. Deformity, subluxation and bony erosion at Rt 2nd PIP joint.
4. Ankylosis at Rt carpal bones.
5. Bony erosion also seen at bilateral distal radio-ulnar joints.
6. Loss of joint spaces is seen at bilateral carpal joints.
7. Deformity seen at Lt carpal bones.
8. Peri-articular soft tissue swelling seen.
9. All the metacarpal epiphyses are square and enlarged in size.
Diagnosis:
Juvenile rheumatoid arthritis
Discussion:
There are 3 main subgroups account for 70% of cases.
1. Systemic onset:
Most common at 1-5 yrs. M=F. Joint involvement is late, but eventually a polyarthritis affects especillay
knees, wrists, carpi, ankles and tarsi.
2. Polyarticular onset:
Onset at any age. More common in females. The cervical spine is involved frequently and early.
3. Pauciarticular or monoarticular onset:
Most commonly presents at 1-5 yrs. Four or less joints involved at the onset, including knees, ankles and
hips are most common.
Radiological Changes:
1. Periarticular soft tissue swelling.
2. Osteopenia- juxta-articular, diffuse or band-like in the metaphyses, the latter particularly in the distal femur,
proximal tibia, distal radius and distal tibia.
3. Acclerated bone growth with large epiphyses and early fusion of growth-plates.
4. Over- or undergrowth of diaphyses.
5. Periostitis- will eventually result in enlarged rectangular tubular bones.
6. Erosions and joint space narrowing are late manifestation.
7. Epiphyseal compression fractures.
8. Subluxation and dislocation
9. Bony ankylosis- especially in the carpus and tarsus
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