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Dr. Jerry E
Dr. Jerry E, Doctor (MD/DO)
Category: Health
Satisfied Customers: 1085
Experience:  1 yr experience family medicine (adult and children), emergency medicine for five years
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Could some one help me with this MRI result. I had spinal

Resolved Question:

Could some one help me with this MRI result. I had spinal fusion 6 months ago, so I understand the hardware part. But the rest is unclear.

I just finished a 6 day course of Methylprednisolone which DRAMATICALLY helped my constitutional symptoms which I have outlined below in my history (to include bloodwork results)

Am I looking at Ankylosing Spondylitis?

Report: MRI OF THE PELVIS:

HISTORY: Persistent chronic low back pain, status post ALIF (anterior lumbar interbody fusion) in March of 2010 and recent plain films of the hips showing questionable subchondral sclerosis.

TECHNIQUE: A 1.5 Tesla magnet was utilized. The following sequences were obtained: sagittal T1,T2, axial T1 andT2 fat-suppressed, coronal T1 and T2 with fat suppression.

FINDINGS: An anterior fusion plate and screws are noted at L5-S1. There is a mild anterolisthesis of L5 on S1. There is some edema in the ilia bilaterally abutting the sacroiliac joints. The findings are compatible with bilateral sacroiliitis. No fractures are identified.

No abnormal signal is noted surrounding the fusion hardware.

IMPRESSION:XXXXX,XXXXX Tue Sep 2819:14:53 PDT 2010

1 . Bilateral sacroiliitis.
2. Surgical changes with anterior fusion plate at L5-S1.

Recent Hx in the past week:
Had a hip/pelvis exam the other day by Dr. E. Pain was elicited from both hips and RLQ abdominal pain was present. He had me go to the lab for a CBC/CMP and radiology (at my request) for a pelvis x-ray. CBC turned up an elevated white blood cell count. Infection seems to have been ruled out due to no fever, etc, so the result was either a fluke or is pointing to some king of inflammation in my body according to the doc. Pelvis x-ray turned up abnormal subchondral sclerosis of the right SI joint on the iliac side. Based upon this result and my history of MRI/CTs with the same result, the radiologists recommended immediate CT/MRI in order to either confirm or rule out possible ankylosing spondylitis, reactive arthritis, or osteoarthritis in conjunction with my current clinical picture.

Chronic low body temp variation: 95.8 to 97.5
ESR- normal
CRP-normal
Folate-low side of normal
Hemoglobin- 13 to 14 (I am a male)

Tests:
Thyroid - normal
Testosterone - normal
RA - Neg
ANA - Neg
Celiac-neg
Lyme-neg
EBV-pos
HIV-neg
Chlamydia-neg
Gonoreaha-neg
Ovum/Parasites-neg

Constitutional Symptoms over the past 4-5 years:
-NO FEVER EVER
-Malaise and just feeling ill
-Depressed mood
-Extreme paralyzing fatigue that comes on quickly and lasts various lengths
-Brain fog
-Free fluid in abdomen as seen on multiple CTs
-Loss of more than 10% over 1-2 months on 4 different occasions in the past 4 years.
-Insomnia for weeks. Am exhausted but cannot sleep not even an hour.
-No appetite.
-recurring painful mouith ulcers under tongue and inside of cheeks
-Migraines without aura which is unusual for me as I used to get them as a kid with aura.
-RLQ abdominal pain with RLQ lymphadenopathy shown on multiple CTs over the past f4 years.
-Non-specific ulcers in my terminal illeum. Crohn's has been ruled out.
-Occasional night sweats.
-As an active duty Marine officer with combat deployments, I have travelled extensively throughout the Middle East and South Asia and have gotten the usual GI infections. Thats most of it...

Any help would be appreciated.
Submitted: 3 years ago.
Category: Health
Expert:  Dr. Jerry E replied 3 years ago.

Hi there, Dr. E from the ER here...

 

Your MRI shows that your L5 vertebrae is pushed slightly forward on S1 vertebrae, but with no obvious nerve findings.

 

As for ankylosing spondylitis, the finding of edema in the ilia does suggest ankylosing spondylitis - in fact it is diagnostic of it! If the radiologist is diagnosing edema within the joint between the sacrum and ilia, then that is called synovitis and it is not necessarily diagnostic. But i'm 90% sure that this report is diagnostic for AS.

 

By the way, not too many things cause ulcers in the terminal ileum other than Crohn's, and Crohn's and AS are intertwined with each other!

 

I hope t his helped,

Dr E

Dr. Jerry E, Doctor (MD/DO)
Category: Health
Satisfied Customers: 1085
Experience: 1 yr experience family medicine (adult and children), emergency medicine for five years
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