60 y/o man with back pain

 

Images

Doctor's Information

Name : Morteza
Family :Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree: Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Ramin Pourghorban,ashraf-o-sadat hoseini

 

Patient's Information

Gender : Male
Age : 60

 

Case Section

Muskuloskeletal System

 

Clinical Summary

60 y/o man with back pain

 

 

Imaging Procedures and Findings

MRI images shows advanced degenerative changes with decreased intervertebral disk height, ankylosis and endplate degenerative change. CT images demonstrates severe DJD,anterior osteophytic changes and suspected intervertebral disk calcification in coronal images. AP and lateral thoracic plain films reveal intervertebral disk calcification and concomitant advanced degenerative changes consistent with Ochronosis.

 

Discussion

Ochronosis is caused by an inherent metabolic flaw resulting in the absence of the enzyme homogentisic acid oxidase. In the second and third decade the most distinctive finding is the laminated calcirication of multiple intervertebral disks. Commonly,all the interspaces are affected and dramatically emphasized by the osteoporosis in the adjoining vertebrae. Universal calcified disks and osteoporosis in the young individual are pathognomonic of ochronosis. The intervertebral disk space is drastically narrowed, but little or no osteophytic lipping appears in the early stages. In older individuals, osteophytic changes occur. In the older patients, massive lipping and ankylosis of the spine result in a severe dorsal kyphosis with a decrease in the lumbar lordosis.

 

Final Diagnosis

Ochronosis(alkaptonuria)

 

References

Edeiken J: roentgen diagnosis of diseases of bone, 2nd ed. Baltimore,: Mosby, 1978.

 

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