SYB Case 1

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SYB Case 1

• By Amy

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History

• 37 y/o female
• Chronic diarrhea/steatorrhea
• Worsened after the birth of her second child in
  January of 2006
• Previously had a colonoscopy and endoscopy, which
  were negative
• Negative stool studies
• Small bowel follow through with thin barium

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Diagnosis

• There is filling of the stomach and small bowel
  to the terminal ileum and into the large bowel.
  There are no strictures. There is no thickening
  of the mucosa. There is no cobblestoning
• Normal small bowel series
• The scout abdominal radiograph and the single
  image of the left sacroiliac joint demonstrate an
  incidental finding of increased density of the
  left ileum adjacent to the sacroiliac joint
• Incidental note is made of left osteitis
  condensans ilii

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DDx

• Ankylosing spondylitis
• Chronic inflammatory disease of the axial
  skeleton manifested by back pain and progressive
  stiffness of the spine
• Characteristically affects young adults with a
  peak age of onset between 20 and 30 years
• Often presents with sacroiliitis, which appears
  as erosions, sclerosis, and joint space
  narrowing, eventually leading to ankylosis
• May cause erosions and osteitis at the ischial
  tuberosities, iliac crest, symphysis pubis, and
  femoral trochanter
• Early sign of spinal involvement is squaring of
  the vertebral bodies due to anterior and
  posterior spondylitis (bamboo spine)
• Several disorders can cause sacroiliitis-like
  changes of the joint, including
  hyperparathyroidism and repetitive shear-stress
  injuries in athletes
• Pagets disease

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Ankylosis of the sacroiliac joint in advanced
ankylosing spondylitis with complete obliteration
of the joint space
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Osteitis Condensans Ilii

• Believed to develop in approx 2 of adults
• Virtually all patients are mutiparous females,
  but it can occur in men
• Age of incidence is between 20-50 years, with a
  mean age of approx 35 years
• Benign sclerosis of the iliac side of the
  sacroiliac joints
• The sclerosis appears triangular with the base
  located inferiorly
• Erosions of the SI joint are absent
• Unlike ankylosing spondylitis, the articular
  margins of the sacroiliac joint are intact and
  the joint space is preserved in OCI and the
  sclerosis involves only the iliac side of the
  joint
• The outer margin of the sclerosis is usually well
  defined
• Usually bilaterally symmetric, but can be
  unilateral
• May spontaneously resolve
• Often found incidentally on X-rays of the pelvis
  or lower back
• Rarely symptomatic, but may be mildly painful
• May also have morning stiffness and
  polyarthralgia

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Osteitis Condensans Ilii

• Theories
• Stress-related sclerotic reaction in the
  peri-articular bone caused by remodeling of bone
  following stress across the sacroiliac joint (and
  possibly also the increased vascularity during
  pregnancy)
• Also may be related to loosening of the pelvic
  ligaments and increased stress on the SI joints
  during pregnancy and childbirth
• Related to a urinary tract infection
• Related to a form of inflammatory arthritis
• If the dx is in doubt, obliquie views of the SI
  joints will show that the joint is intact

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• Sclerosis of the ileum adjacent to the
  sacroiliac joint
• Typically bilateral, symmetrical, and
  triangular in shape
• SI joint is normal with no irregularity,
  erosions or loss of joint space

www.learningradiology.com
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http//www.mypacs.net/cases/OSTEITIS-CONDENSANS-IL
II-333821.html
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References

• Tuite, MJ. Sacroiliac joint imaging. Seminars in
  Musculoskeletal Radiology. 12(1)72-82, 2008 Mar.
• http//www.radpod.org/2007/09/28/osteitis-condensa
  ns-ilii/
• www.learningradiology.com
• http//www.mypacs.net/cases/OSTEITIS-CONDENSANS-IL
  II-333821.html
• Nykoliation, JW, et al. Osteitis condensans ilii
  a sacroiliac stress phenomenon A report of a
  case. Journal of the CCA. 28(1) 209-211, 1984
  Mar.
• Vadivelu, R, et al. An uncommon cause of back
  pain in pregnancy. Postgrad Med J 2005
  8165-67.
• UpToDate