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Case studies in diagnostic imaging
Bloody arthritis
  1. D J Annesley-Williamsa,
  2. A Mark Daviesb,
  3. N Evansb
  1. aDepartment of Radiology, North Staffordshire Hospital Trust, Stoke-on-Trent, United Kingdom , bThe MRI Centre, The Royal Orthopaedic NHS Trust, The Woodlands, Birmingham, United Kingdom
  1. Dr D J Annesley-Williams, 43 Ormes Lane, Tettenhall, Wolverhampton WV6 8LL.

https://doi.org/10.1136/ard.56.1.12

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    Clinical history

    A 25 year old carpenter presented with a two day history of intense pain in the left ankle. The pain started suddenly when he injured the ankle while working in the joinery, and had been getting steadily worse ever since. The patient was known to suffer from a chronic haematological disorder, and had previously experienced multiple similar episodes affecting in particular the left ankle and right knee joints, often following minor trauma.

    On examination he held the ankle dorsiflexed and was unable to weight bear. Movement was limited in all directions. The ankle appeared swollen and was exquisitely tender to palpation. Examination was otherwise normal. The patient was apyrexial. Serological tests (rheumatoid factor, erythrocyte sedimentation rate, C reactive protein) were negative. Plain radiographs and magnetic resonance images of the knee and ankle joints were obtained.

    Radiological findings

    PLAIN RADIOGRAPHIC FINDINGS

    Radiographic examination of the left ankle (fig 1) shows a joint effusion with prominence of the soft tissue both anterior and posterior to the joint. The anterior joint space is narrowed with erosions and a large subarticular cyst in the distal tibia. The bones are osteopenic.

    Figure 1

    Lateral radiograph of the ankle joint showing osteopenia, joint space narrowing, and a subarticular cyst in the distal tibia.

    The right knee joint (fig 2) shows signs of chronic hyperaemia; loss of secondary trabeculae in the period of osteopenia has lead to coarsening of the epiphyseal trabecular pattern. The intercondylar notch is widened and there is joint space narrowing affecting both compartments of the knee joint.

    Figure 2

    Anteroposterior radiograph of the knee joint showing coarsening of the trabecular pattern of the epiphyses and widening of the femoral intercondylar notch. There is loss of joint …

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