Bilateral sakroileiti taklit eden multiple yetmezlik kırığı

Year 2020, , 817 - 821, 18.09.2020

Hakan Alkan , Ayşe Sarsan , Necmettin Yıldız , Saadet Öztekin

https://doi.org/10.31362/patd.746054

Abstract

Bu olgu sunumunun amacı, bilateral sakroileit ayırıcı tanısı için kliniğimize yönlendirilen yaşlı kadın hastada saptanan multiple yetmezlik kırığı gelişmiş olan olguyu sunmaktı. Yetmiş bir yaşında kadın hasta, bel ağrısı ve ayrıca her iki kalça ve kasık bölgesinde ağrı şikayeti ile polikliniğimize başvurdu. Hastanın kas-iskelet sistemi muayenesinde, bel fleksiyonu ve ekstansiyonu kısıtlı ve ayrıca bilateral kalça rotasyonları ağrılı idi. Bilateral Faber, Mennel ve sakroiliak kompresyon testleri pozitifdi. Hastanın laboratuvar incelemesinde 25-hidroksi-Dvit seviyesi 3 ng/ml ve parathormon seviyesi 70 pg/ml olarak saptandı. Fizik muayene ile uyumlu olarak pelvik radyografide sakroiliak eklemde bilateral subkondral skleroz, koksafemoral eklem aralığında daralma, symphisis pubiste düzensizlik saptandı. Sakroiliak manyetik rezonans görüntüleme, her iki sakroiliak eklemi oluşturan periartiküler yüzeylerde T1 ağırlıklı görüntülerde yaygın hipointens ve STIR görüntülerinde hiperintens sinyal değişikliği ve ayrıca T1 ağırlıklı görüntülerde kırık çizgileri saptandı. Sonrasında çekilen sakroiliak bilgisayarlı tomografide ise sakrumun ön yüzünde, bilateral iliak kemiklerde ve pubik ramusta multiple yetersizlik kırığı hatları saptandı. Hastaya vitamin D eksikliğine bağlı multiple yetmezlik kırığı tanısı konuldu. D vitamini replase edildi ve konservatif tedavisi planlandı. Sonuç olarak bel ağrısı ile başvuran ve görüntülemede sakroileiti taklit edebilen eklem değişiklikleri olan yaşlı hastalarda, ayırıcı tanıda yetmezlik kırıkları göz önünde bulundurulmalıdır.

Keywords

sakroileit, stres kırığı, vitamin d eksikliği

Multiple insufficiency fractures mimicking bilateral sacroiliitis

Abstract

The aim of this case report was to represent a case with multiple insufficiency fractures detected in an elderly female patient who was referred to our clinic for the differential diagnosis of bilateral sacroiliitis. A 71-year-old female patient was admitted to our outpatient clinic with the complaint of low back pain and also pain in her both hips and groin. On assessment of her musculoskeletal system, she had limited range of motion for low back and also had bilateral painful hip rotations. Bilateral Faber, Mennel and sacroiliac compression tests were positive. In her laboratory examination, 25-hydroxy-Dvit level was 3 ng/ml and parathormone level was 70 pg/ml. In consistent with physical examination pelvic radiograph revealed bilateral subchondral sclerosis in the sacroiliac joint, narrowing in the coxafemoral joint space, irregularity in symphisis pubis. Sacroiliac magnetic resonance imaging showed diffuse hypointense signal on T1-weighted images and hyperintense signal change on STIR images in the periarticular surfaces of bilateral sacroiliac joints and also fracture lines were detected on T1-weighted images. Subsequently, multiple insufficiency fracture lines were detected on the anterior face of the sacrum, bilateral iliac bones and the pubic ramus on the sacroiliac computed tomography. The patient was diagnosed with multiple insufficiency fractures due to vitamin D deficiency. Vitamin D was replaced and conservative treatment was planned. In conclusion, insufficiency fractures should be considered in differential diagnosis in elderly patients who present with low back pain and who have joint changes that may mimic sacroiliitis in imaging.

Keywords

sacroiliitis, stress fractures, vitamin D deficiency

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