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Inflammatory Disease

  • “Although the primary imaging modality for the evaluation of inflammatory arthritis of the foot and ankle is currently magnetic resonance imaging, computed tomography may be performed in some patients and can aid in diagnosis. This article reviews a number of inflammatory arthritic conditions that involve the feet. Computed tomographic findings and the role of computed tomography in diagnosing infection, gout, and rheumatoid arthritis of the foot are discussed.”
    CT of the foot: select inflammatory arthridites
    Johnson PT, Fayad LM, Fishman EK
    J Comput Assist Tomogr 2007 Nov-Dec;31(6):961-9
  • Castleman’s Disease: Two Types
    - Plasma cell type (less vascular)
    - Hyaline vascular form (vascular)
  • Castleman’s Disease: Location
    - Thorax (67-70%)
    - Neck (14-40%)
    - Abdomen including retroperitoneum (2-7%)
  • Castleman’s Disease is also known as
    - Angiofollicular hyperplasia
    - Giant lymph node hyperplasia
  • "In particular the combination of ascites, elevated CA-125 levels, and pelvic and peritoneal masses found in tuberculosis can be easily mistaken for coelomic spread of ovarian cancer."

    Tuberculosis: A Benign Imposter
    Tan CH et al.
    AJR 2010; 194:555-561

  • "Peritoneal involvement in tuberculosis is present in 5% of cases and is usually associated with widespread abdominal disease involving the lymph nodes or bowel"

    Tuberculosis: A Benign Imposter
    Tan CH et al.
    AJR 2010; 194:555-561

     

  • "Spondylitis is the most common form of skeletal tuberculosis infection, accounting for 60% of cases."

    Tuberculosis: A Benign Imposter
    Tan CH et al.
    AJR 2010; 194:555-561

  • Musculoskeletal Infection: Who is at risk?

    - HIV/AIDS patients
    - IVDA patients
    - Sickle cell disease
    - Diabetic patients
    - Periperal vascular disease
    - Immunocomprimised patients
  • "CT provides an analysis of compartmental anatomy, thereby helping to distinguish among the various types of musculoskeletal infection and to guide treatment options."

    Musculoskeletal infection: Role of CT in the Emergency Department
    Fayad LM, Carrino JA, Fishman EK
    RadioGraphics 2007;27:1723-1736
  • “ Spondylitis is the most common form of skeletal tuberculosis infection, accounting for 60% of cases.”

    Tuberculosis: A Benign Imposter
    Tan CH et al.
    AJR 2010; 194:555-561
  • “ Peritoneal involvement in tuberculosis is present in 5% of cases and is usually associated with widespread abdominal disease involving the lymph nodes or bowel.”

    Tuberculosis: A Benign Imposter
    Tan CH et al.
    AJR 2010; 194:555-561
  • “ In particular the combination of ascites, elevated CA-125 levels, and pelvic and peritoneal masses found in tuberculosis can be easily mistaken for coelomic spread of ovarian cancer.”

    Tuberculosis: A Benign Imposter
    Tan CH et al.
    AJR 2010; 194:555-561
  • Fournier's Gangrene

    - Described in 1883
    - Unexplained fulminating gangrene of the male genitalia
    - Young healthy males, no discernible cause
    - Today, broader age range, Males and Females
    - Source can be identified in up to 95% of cases
    - Successful treatment depends on early diagnosis and aggressive surgical intervention
    - 76% mortality if delay > 6 days
    - 12% mortality rate if < 24 hours before surgical debridment.
  • Fournier's Gangrene

    - Causes Are:
    - Trauma: Provides access of organisms to subcutaneous tissues
    - Extension of UTI
    - Extension from infection in perineal area
    - Comorbid conditions often present
    - ETOH, DM, Malignancy, Advanced age, Prolonged hospitalization
    - Clinical Presentation Fever, pain, pruritis, swelling, vesicles, discharge, crepitus
  • Fournier's Gangrene

    - Pathogenesis:
    - Severe subcutaneous infection that begins adjacent to the portal of entry (urethral, rectal, cutaneous)
    - Localized cellulitis progresses to diffuse inflammatory reaction involving the deep tissue planes
    - Can progress 2-3 cm per hour
    - The subcutaneous infection and edema impairs blood supply and results in cutaneous and subcutaneous vascular thrombosis (Necrotizing fasciitis)
  • Fournier's Gangrene

    - Pathogenesis:
    - Most common organisms (usually 4 or more)
    - Klebsiella, Proteus, Streptococcus, Staphlococcus, Peptostreptococcus, E.coli
    - Organisms act synergistically to produce fascial and soft tissue necrosis
    - Gas is byproduct of anaerobic metabolism (Nitrogen, nitrous oxide, hydrogen and hydrogen sulfate).