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Age / Sex : 67 / M
Chief complaint: both shoulder pain
History: chronic renal failure 로 투석 중
What is your diagnosis?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)
Courtesy : 김상윤 (Sang Yoon Kim), 단국대학교병원 (Dankook University Hospital)
Diagnosis: Amyloid arthropathy
Discussion
Findings
1. Peri-articular soft tissue swelling & mild peri-articular osteoporosis of both shoulders
2. Subchondral erosion & sclerosis in both humeral heads and scapular glenoids
3. Synovitis with low signal intensity joint effusion & capsular thickening
4. Multi-focal low signal intensity mass-like lesions in antero-inferior peri-articular soft tissue
5. Massive rotator cuff tear
Discussion
Amyloidosis due to the accumulation of beta-2 macroglobulin occurs in patients with CRF on long-term hemodialysis.
Amyloid arthropathy may be similar to an erosive arthropathy due to the presence of subchondral erosions and juxta-articular osteoporosis.
On MRI, amyloid arthropathy show diffuse nodular synovial thickening with low signal intensity on T2WI and T1WI sequences.
Differential diagnoses include gout, tenosynovial giant cell tumor, hemophilia, which also demonstrate low signals on fluid-sensitive sequences.
Reference
Hau Wei Khoo et al. Radiologic Findings in Polyarticular Amyloid Arthropathy and Myopathy in Multiple myeloma: A Case Report. Am J Case Rep. 2018; 19: 1398-1404
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