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Challenge of the Unknowns—Unknown 2

Radiographic Findings and Differential Diagnosis

Click images to review films and listen to further audio discussion by Dr. Stephen Fridinger.


LUMBAR SPINE: Among other postural alterations note the diminished lumbar lordosis. There are thin linear opacities of the anterior portion the disc margin representing marginal syndesmophytes, ossification of the outer annulus, throughout the lumbar spine with the exception of L5-S1. On the frontal film, these syndesmophytes produce a so called "bamboo spine". The facet joints appear to be ankylosed, bilaterally, throughout the entire lumbar spine with the exception of L5-S1. The sacroiliac joints are fused bilaterally, with osseous fusion of the upper portion of the joints creating "star signs." Ankylosis of the costovertebral joints at T12, bilaterally, is also noted. Note the calcification of the abdominal aorta and common iliac arteries.

For the differential diagnosis in this case, the following may be considered:

1. Diffuse Idiopathic Skeletal Hyperostosis (DISH)

2. Psoriatic Arthritis

3. Ankylosing Spondylitis

4. Reiter's Disease



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Introduction to Unknown Cases

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