Radiological Evaluation of Septic Arthritis
- 1. PGT, Dept of Radiology, Silchar Medical College & Hospital, Silchar, Assam, India
- 2. Associate Professor, Dept of Radiology, Silchar Medical College & Hospital, Silchar, Assam, India
Description
Introduction: Inflammation of joints by pyogenic bacteria results in septic arthritis. It is an emergency condition, which needs early diagnosis & treatment. Delay results in cartilage & joint destruction resulting in significant morbidity & mortality. The prevalence of septic arthritis patients in the emergency department varies significantly between studies. Higher rates of septic arthritis are present in immune-compromised patients and those with prosthetic joints. X-ray is commonly used for joint imaging as it is widely available. CT & MRI gives more precise information on joints & adjoining soft tissue involvement. Aim: The aims and objectives of this study were to evaluate age, sex distribution & the pattern of involvement of septic arthritis. Method: It is an observational study conducted in the Department of Radiology, Silchar Medical College & Hospital (SMCH), Silchar, Assam, India from 1st June 2017 to 31st May 2018, for one year, after taking approval from the ethical committee of Silchar Medical College and Hospital, Silchar in clinic-pathologically confirmed cases of septic arthritis. A total of 23 patients of confirmed septic arthritis patients were evaluated with X-ray, CT & MRI. These findings were compared using suitable statistical methods. Result: Of 23 cases of septic arthritis, the high incidence was found in the range 20-40 years (16 cases) followed by 40-60 years (4 cases).17 cases (74%) were males and 6 cases (26%) were females. The most common radiographic finding in septic arthritis was the presence of marginal erosions followed by joint effusion, joint space narrowing and periarticular osteoporosis. On USG joint effusion and synovial thickening were seen in all cases. Synovial hyperemia in the Doppler study was noted in 20 cases. Joint effusion contained echogenic contents in a maximum number of cases. On CT, erosions and joint effusion were seen in all cases. Synovial thickening was seen in 20 cases and joint space narrowing in 12 cases. On MRI, erosions, bone marrow oedema, joint effusion, and synovial thickening with enhancement were seen in all cases. Soft tissue involvement was seen in 10 cases. Conclusion: Imaging plays a vital role in diagnosing a case of septic arthritis and thereby decreasing both mortality and morbidity. Plain radiography is the basic first-line investigation. Ultrasound had an excellent sensitivity in diagnosing joint effusions, soft tissue changes and synovial thickening. CT also has a definitive role; however, radiation risks narrow down its use. MRI is the imaging modality of choiceas it is both specific and sensitive. The only limitation is high cost and more time consumed. The sensitivity of diagnosing septic arthritis by MRI was 100%, by CT was 91.3%, by Radiography was 70% and by USG was 43.5%.
Abstract (English)
Introduction: Inflammation of joints by pyogenic bacteria results in septic arthritis. It is an emergency condition, which needs early diagnosis & treatment. Delay results in cartilage & joint destruction resulting in significant morbidity & mortality. The prevalence of septic arthritis patients in the emergency department varies significantly between studies. Higher rates of septic arthritis are present in immune-compromised patients and those with prosthetic joints. X-ray is commonly used for joint imaging as it is widely available. CT & MRI gives more precise information on joints & adjoining soft tissue involvement. Aim: The aims and objectives of this study were to evaluate age, sex distribution & the pattern of involvement of septic arthritis. Method: It is an observational study conducted in the Department of Radiology, Silchar Medical College & Hospital (SMCH), Silchar, Assam, India from 1st June 2017 to 31st May 2018, for one year, after taking approval from the ethical committee of Silchar Medical College and Hospital, Silchar in clinic-pathologically confirmed cases of septic arthritis. A total of 23 patients of confirmed septic arthritis patients were evaluated with X-ray, CT & MRI. These findings were compared using suitable statistical methods. Result: Of 23 cases of septic arthritis, the high incidence was found in the range 20-40 years (16 cases) followed by 40-60 years (4 cases).17 cases (74%) were males and 6 cases (26%) were females. The most common radiographic finding in septic arthritis was the presence of marginal erosions followed by joint effusion, joint space narrowing and periarticular osteoporosis. On USG joint effusion and synovial thickening were seen in all cases. Synovial hyperemia in the Doppler study was noted in 20 cases. Joint effusion contained echogenic contents in a maximum number of cases. On CT, erosions and joint effusion were seen in all cases. Synovial thickening was seen in 20 cases and joint space narrowing in 12 cases. On MRI, erosions, bone marrow oedema, joint effusion, and synovial thickening with enhancement were seen in all cases. Soft tissue involvement was seen in 10 cases. Conclusion: Imaging plays a vital role in diagnosing a case of septic arthritis and thereby decreasing both mortality and morbidity. Plain radiography is the basic first-line investigation. Ultrasound had an excellent sensitivity in diagnosing joint effusions, soft tissue changes and synovial thickening. CT also has a definitive role; however, radiation risks narrow down its use. MRI is the imaging modality of choiceas it is both specific and sensitive. The only limitation is high cost and more time consumed. The sensitivity of diagnosing septic arthritis by MRI was 100%, by CT was 91.3%, by Radiography was 70% and by USG was 43.5%.
Files
IJPCR,Vol14,Issue7,Article46.pdf
Files
(469.6 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:d5f164eab6747e714a05cfc039507f62
|
469.6 kB | Preview Download |
Additional details
Dates
- Accepted
-
2022-07-07
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue7,Article46.pdf
- Development Status
- Active
References
- 1. Learch, T. J. & Farooki, S. Magnetic resonance imaging of septic arthritis. Clin. Imaging 2000:24, 236–242. 2. Cisternas, M. G. et al. Trends in Medical Care Expenditures of US Adults with Arthritis and Other Rheumatic Conditions 1997 to 2005. J. Rheumatol. 2009:36, 2531–2538. 3. Cooper, C. & Cawley, M. I. Bacterial arthritis in an English health district: a10-year review. Ann. Rheum. Dis. 1986:45, 458–463. 4. Ogunlusi, J. D., Ogunlusi, O. O., Oginni, L. M. &Olowookere, J. A. Septic Arthritis in a Nigerian Tertiary Hospital. Iowa Orthop. J. 2006:26, 45–47. 5. Al, -Saleh Salman, Al, -Arfaj Abdurahman, Naddaf, H., Haddad, Q. &Memish, Z. Tuberculous Arthritis: A Review of 27 Cases. Ann. Saudi Med. 1998:18, 368–369. 6. Morgan, D. S., Fisher, D., Merianos, A. & Currie, B. J. An 18-year clinical review of septic arthritis from tropical Australia. Epidemiol. Infect. 1996:117, 423–428. 7. Hadadi, A., Rasoulinejad, M., Khashayar, P., Mosavi, M. & Morad, M. M. Osteoarticular tuberculosis in Tehran, Iran: a 2-year study. Clin. Microbiol. Infect. 2010:16, 1270–1273. 8. Huang, T.-Y. et al. Tuberculous arthritis- -a fourteen-year experience at a tertiary teaching hospital in Taiwan. J. Microbiol. Immunol. Infect. Wei Mian Yu Gan Ran Za Zhi 2007:40, 493–499. 9. Mnif, J. et al. [Ultrasonography in the diagnostic approach of septic arthritis]. Rev. Chir. Orthop. Reparatrice Appar. Mot. 1997:83, 148–155. 10. Draghi, F. et al. Joint effusion of the knee: potentialities and limitations of ltrasonography. J. Ultrasound 2015:18, 361–371. 11. Shiv, V. K., Jain, A. K., Taneja, K. & Bhargava, S. K. Sonography of hip joint in infective arthritis. Can. Assoc. Radiol. J. J. Assoc. Can. Radiol. 1990:41, 76– 78. 12. Prasad, S. et al. Features of extra-spinal musculoskeletal tuberculosis: A retrospective study from a North Indian Tertiary Care Institute. Indian J. Rheumatol. 2017:12, 146. 13. Graif, M., Schweitzer, M. E., Deely, D. & Matteucci, T. The septic versus nonseptic inflamed joint: MRI characteristics. Skeletal Radiol. 1999:28, 616–620. 14. Choi, J.-A. et al. Rheumatoid Arthritis and Tuberculous Arthritis: Differentiating MRI Features. Am. J. Roentgenol. 2009:193, 1347–1353. 15. Karchevsky, M., Schweitzer, M. E., Morrison, W. B. & Parellada, J. A. MRI Findings of Septic Arthritis and Associated Osteomyelitis in Adults. Am. J. Roentgenol. 2004:182, 119–122. 16. Hopkins, K. L., Li, K. C. & Bergman, G. Gadolinium-DTPA-enhanced magnetic resonance imaging of musculoskeletal infectious processes. Skeletal Radiol. 1995:24, 325–330.