case_images: PMC9459495_01
case_images: Cervical magnetic resonance image (MRI) (A, B, C) showing areas of
  altered signal, hyperintense in T2-weighted images involving the
  articular surfaces of the joint between the atlas and epistrophe
  on the right side (A: axial fat suppression T2-weighted
  sequences), gaining the contrast medium and surrounding a large
  area of osteorarefaction compatible with osteolysis (B: axial
  postcontrast T1-weighted images). Voluminous anterior somatic
  osteophytes (not significantly compressing the esophagus) and
  posterior osteophytic disk bars which mark the anterior profile
  of the medulla at several levels (C: sagittal fat suppression
  T2-weighed sequences). No areas of altered spinal cord signal
  are detected. Neck computed tomographic (CT) scan (D, E). As
  partially visible in neck MRI, in CT images the focal osteolytic
  alteration involving the right side of the apex of the tooth and
  the atloaxial joint, associated with irregular bone margins due
  to the presence of fine erosions, is confirmed (D: coronal view;
  E: axial view). (F) shows lateral radiography of the cervical
  spine, which demonstrated a posterior dislocation of the atlas
  with respect to the axis. Simultaneously, aspects of
  spondyloarthrosis are appreciable in the C3-C7 cervical tract
  with reduction in thickness of almost all the related
  intersomatic spaces.
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case_images: After admission, neck MRI revealed hyperintensity in T2-weighted sequences on the articular surfaces of the right atlo-epistrophic joint (Figure 1A), with contrast enhancement surrounding a large area of osteolysis (Figure 1B). Anterior somatic and posterior disk osteophyte bars slightly imprinting the medulla anterior profile without impairing the spinal cord were also appreciable (Figure 1C). Computed tomographic (CT) scan confirmed the presence of the osteolytic lesion on the right side of the atloaxial joint with irregular margins due to the presence of fine erosion (Figure 1D and E). A mild posterior subluxation of the atlantoaxial joint with right dislocation of the epistrophic tooth with respect to the atlas was documented, together with the presence of an areola of cortical erosion on the right side of the apex of the tooth (Figure 1F).
case_images: Whole-body [18F]2-Deoxy-2-fluoro-d-glucose positron
  emission tomography imaging showing the presence of modest focal
  hypercaptation of the radiotracer (SUV max 4.8) in
  correspondence with the known structural alterations of the
  articular surfaces between the atlas and the epistrophe on the
  right side (A: sagittal view; B: coronal view).
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case_images: Consequently, the patient underwent total-body [18F]2-Deoxy-2-fluoro-d-glucose (FDG) positron emission tomography (PET) examination, which only revealed isolate mild hypercaptation at the atlantoepistrophic level (SUV max 4.8) (Figure 2).
case_images: Bone scintigraphy exhibiting modest hyperfixation in correspondence
  with the articular passage between the atlas and the epistrophe
  of the right side, site of known osteo-structural alterations
  described in magnetic resonance imaging and computed tomographic
  images. Mild hyperfixation at the scapular girdle, lumbar L4-L5
  levels (site of known spondylolisthesis), and trapeziometacarpal
  joint of both hands, on a degenerative basis.
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case_images: Bone scintigraphy was also performed, confirming isolate mild hypercaptation at the same level (Figure 3).
case_images: (A and B) Histopathological finding revealing the band-like
  complete loss of elastic fibers in the mid-dermis, annotated
  with dotted lines, properly studied by elastic stains; elastic
  fiber fragmentation is also detected (Weigert stain, 5x
  magnification/A and 20x magnification/B). (C) Hematoxylin and
  eosin staining did not reveal pathological findings except for
  slight lymphohistiocytic perivascular infiltrates around the
  vessels of the superficial plexus in the lesional sites. There
  is no evidence of dermal actinic damage such as elastosis (5x
  magnification). (D) Immunolabelling for CD163 (a marker of
  monocytic/histiocytic lineage) revealed a discrete increased
  number of interstitial histiocytes/macrophages engulfing elastic
  fibers within the mid-dermis and occasional figures of
  elastophagocytosis (5x magnification).
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case_images: Chest magnetic resonance imaging. At the level of the right
  sternoclavicular joint, a periarticular and intra-articular
  effusion is observed (A: axial T1-weighed image; B: axial Short
  tau inversion recovery [STIR] image). Reactive sponge edema of
  the medial extremity of the right clavicle is appreciated, in
  the context of millimetric areas of hyperintense signal in the
  long TR sequences in the subchondral area, referable in first
  hypothesis to pseudocystic aspects or erosions (C: coronal STIR
  image).
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case_images: Chest MRI revealed intra-articular effusion with marked bone edema of the medial extremity of the right sternoclavicular joint and millimetric pseudocystic aspects of the bone (Figure 5).