CaseDisscusionByGroupGroup2013-07-112011-06-02CaseDisscusionByGroupGroup21HistoryMale,28yearsoldHippainNolaboratoryexaminationHistoryMale,28yearsold2強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)3強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)4強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)5強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)6強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)7強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)8強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)9強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)10強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)11強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)12強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)13FinalDiagnosisbilateralsacroiliitisseronegativespondyloarthropathyinvolvebilatrealhipjointsynovialcystatthefrontmarginofarticularFinalDiagnosisb14ASmainlyyoungadults,mostlymaleage:10to40yearsold,average25hipinvolved——one-thirdofpatientswithASHLA-B27positive>90%axialskeletal:bilaterallyperipheralarthritis:asymmetricallyASmain15ASconventionalradiographstwotypicalfeaturesconcentricosteoproliferationwithosteophytesaroundthefemoralneckerosionsoftheacetabulumASconv16強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)17ASconventionalradiographsotherssclerosissynovitis;enthesitisosteophytosisjointspacenarrowing——concentric,uniformjointeffusionsubchondralbonemarrowedemaperiarticularfatdepositionsASconv18強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)19強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)20強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)21強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)22強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)23DDXRheumatoidarthritis(RA)Tuberculosis(TB)DDXRheu24RAautoimmunedisorderofunknownetiologycharacteristicsymmetricerosivesynovitissometimesmultisysteminvolvementhipinvolved——5to15%mainlywomenRAaut25RAclinicalsymptompainswellingstiffnessmotionimpairmentlaboratorytestsrheumatoidfactor(+)elevatedESRandCRPRAclin26RAimagingappearancesynovitisthickeningofsofttissueosteoporosissubchondralcystformationhomogeneousnarrowingofarticularspaceerosionofcartilageacetabulumandheadoffemurbothinvolvedRAimag27RAimagingappearanceMRIearlystage(richvesselsofpannus)T1WI——lowsignalT2WI——highsignallatestage(increasedfabrecomposition)T1WI——isosignalT2WI——isosignalRAimag28

29RAsynovialcyst——rareRAsyn30強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)31強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)32TBpathogenesis—hematogenousdissemination15%casesofosteoarticulartuberculosiscommonage——thesecondandthirddecadesthemostcommonsite——vertebraltuberculosisTBpath33TBlesionsontheacetabularsideprogresslessrapidlythanlesionsonthefemoralsideTBles34TBclinicalsymptomcommonsymptomjointsymptompainfixeddeformitiesofthehippainfullimitationofmovementmusclewastingregionallymphnodeenlargementformofcoldabscesswithorwithoutsinusespathologicdislocationofthehipTBcli35強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)36TBimagingappearancethickeningofthesynoviumsubchondralandmarginalbonyerosioneffusionlossofjointspaceperiarticularabscessjuxta-articularosteoporosisTBimag37強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)38強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)39強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)40強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)41強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)42強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)43強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)44強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)45強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)46強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)47TBhipdislocation——uncommonTBhip48強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)49TBtuberculousbursitis——rarecommonsite——trochantericregionTBtub50強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)51強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)52hipjointarthritisclinicalsymptom、agegender、laboratoryexaminationHLA-27(+)ASRF(+)RATuberclebacillus

TBimagingappearanceenthesitis、osteophytosis、combinedSIJandspinechangesASobvioussynovitispolyarticular、boneerosion、uniformnarrowingRAmonoarticularnonuniformnarrowingbonedestructionTBFinaldiagnosiscombinationhipjointarthritisclinicalsy53ThankYou!MadebychaichaoThankYou!Madebychaichao54RA

JointTBPVNSGoutyJointinvolvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%Thefirstmetatarsophalangeal