Radiologic vignette

Abstract

The patient is a 68-year-old man with end-stage renal disease, in whom kidney transplantation had been unsuccessful. He had been receiving hemodialysis for 20 years. He had had a carpal tunnel release and now presents with increasing pain and swelling in the shoulders, wrists, knees, and hips.Well-defined erosion of the femoral neck with preservation of the femoral head suggests the presence Radiologic findingsAn anteroposterior view of the pelvis (Figure 1) shows multiple surgical clips, generalized osteopenia, and vascular calcifications. These findings are consistent with the patient's history of chronic renal failure and transplantation. In addition, there are prominent erosions of the femoral necks bilaterally, with good preservation of the hip cartilage. A well-defined left acetabular lucent lesion is present (Figure 2).

Imaging of Amyloid Arthropathy

“…The differential diagnosis of the radiographic appearance of amyloid arthropathy includes pigmented villonodular synovitis (PVNS), uncalcified synovial osteochondromatosis, tuberculous arthritis, rheumatoid arthritis, silicone synovitis, and gout. 1,14,39,44 PVNS is similar to amyloid arthropathy on MR images, demonstrating erosions with low signal intensity on both T1-and T2-weighted sequences and preser- vation of the joint space. Unlike amyloid arthropathy, however, PVNS is monoarticular.…”

“…14 Characteristic findings include asymmetric soft tissue masses, periarticular osteoporosis, preservation of the articular space, subchondral cysts, joint effusions, and erosions. 1,14,32,35,[39][40][41][42][43] Although the literature states that juxta-articular osteoporosis accompanies the radiographic changes of amyloidosis, this was not a feature of our patients. The symmetrical joint involvement and erosions are similar to rheumatoid arthritis, but the preser- vation of joint space and absence of juxta-articular osteoporosis is more characteristic of amyloid arthropathy (Fig.…”

“…Pathologic fractures are frequently seen, particularly if the femoral neck is involved. 44,45 Destructive spondyloarthropathy is characterized by end-plate erosions, disc space narrowing, and absence of osteophytes, 1,39,41,43,45,46 mimicking the radiographic appearance of infectious spondylitis (Fig. 3).…”

Amyloid, advanced glycation end products, and dialysis related arthropathy

“…Plain radiology, synovial fluid aspiration, nuclear scans, ultrasound, and MRI have all been described as investigative tools of variable utility. The changes seen by plain radiology are well described; principal features are subchondral bone cysts, especially in the acetabulum, carpal bones, and distal radius and ulna 20. Although the full pattern is distinctive, it may be impossible to distinguish early changes from osteoarthritis, hyperparathyroidism or even aluminium related bone disease.…”