Age / Sex : 29 / M

Age/Sex: 29/M

C.C.: left ankle pain and swelling

hemophilia

Discussion

Hemophilia

•       joint involvement – knee, elbow, ankle, hip, shoulder in descending order of

                                         frequency

•       usually a single joint is involved in each episode

•       joint involvement may be markedly asymmetric or even unilateral

Hemophilia - ankle involvement

•       X-ray findings: similar to those in other involved joints

•       Soft tissue swelling, osteoporosis, marginal and central osseous erosions, and joint

   space narrowing

•       tibiotalar slanting or tilt à angular joint surface

  : presumably related to abnormal growth and premature fusion of the distal tibial

      physis

  : DDx – epiphyseal dysplasia, juvenile chronic arthritis, sickle cell anemia

•       ankle and foot deformities – not infrequent

  : plantar flexion of the ankle, inversion of the subtalar joints, adduction of the

      forefoot

: relate to intra-articular and intramuscular bleeding

The stages of hemophilia by Arnold and Hilgartner

Stage I: Soft tissue swelling

   joint effusion

Stage II: Osteoporosis

  periarticular osteoporosis

Stage III: Osseous lesions

  irregularity and erosion of bone with subchondral cysts

  joint effusion may appear relatively radiodense owing to hemosiderin deposition

Stage IV: Cartilage destruction

  joint space narrowing with the bony abnormalities

  narrowing frequently is symmetric, involving the entire articulation

Stage V: Joint disorganization

 severe cartilaginous and osseous abnormalities

 complete obliteration of the joint space, considerable bony erosion and irregularity,

 multiple cystic radiolucent lesions, secondary “degenerative” alterations

Reference

Diagnosis of Bone and Joint Disorders, Resnick D