Imaging Findings in Musculoskeletal Complications of AIDS
Carlos S. RestrepoDiego F. LemosH GordilloRichard OderoThomas K. VargheseWilliam TiemannFrancisco F. RivasRogelio MoncadaCarlos R. Giménez
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Abstract:
Patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are susceptible to a variety of complications that can affect the musculoskeletal system. These complications can be infectious, inflammatory, or neoplastic or can take some other form. Infection (cellulitis, necrotizing fasciitis, soft-tissue abscess, pyomyositis, osteomyelitis, septic arthritis) is the most common complication. Inflammatory processes include various arthritides as well as polymyositis. Non-Hodgkin lymphoma and Kaposi sarcoma are the two most common neoplasms in this patient population. Miscellaneous disorders include osteonecrosis, osteoporosis, rhabdomyolysis, anemia-related abnormal bone marrow, and hypertrophic osteoarthropathy. The underlying mechanisms leading to these diseases are complex and not fully understood but are thought to be multifactorial. Radiology may play an important role in early diagnosis and treatment planning in this population, in whom clinical and laboratory findings are commonly equivocal and nonspecific. Although biopsy is often necessary for the final diagnosis, it is important for the radiologist to be familiar with the different types of musculoskeletal disease in HIV-positive and AIDS patients so that an appropriate differential diagnosis can be established. © RSNA, 2004Keywords:
Pyomyositis
Musculoskeletal infection is commonly encountered in the emergency department and can take many forms, depending on the involvement of the various soft-tissue layers, bones, and joints. Infection may manifest as superficial cellulitis, necrotizing or nonnecrotizing fasciitis, myositis, a soft-tissue abscess, osteomyelitis, or septic arthritis. Because clinical parameters for the detection of musculoskeletal infection generally lack sensitivity and specificity, computed tomography (CT) plays an important role in the assessment of potential musculoskeletal infections in the emergency department. CT provides an analysis of compartmental anatomy, thereby helping to distinguish among the various types of musculoskeletal infection and to guide treatment options. Specific imaging features exist that help identify the numerous forms of infection in the bones and soft tissues, and CT is invaluable for detecting deep complications of cellulitis and pinpointing the anatomic compartment that is involved by an infection. Although all patients with musculoskeletal infection will require treatment with antibiotics, CT
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Patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are susceptible to a variety of complications that can affect the musculoskeletal system. These complications can be infectious, inflammatory, or neoplastic or can take some other form. Infection (cellulitis, necrotizing fasciitis, soft-tissue abscess, pyomyositis, osteomyelitis, septic arthritis) is the most common complication. Inflammatory processes include various arthritides as well as polymyositis. Non-Hodgkin lymphoma and Kaposi sarcoma are the two most common neoplasms in this patient population. Miscellaneous disorders include osteonecrosis, osteoporosis, rhabdomyolysis, anemia-related abnormal bone marrow, and hypertrophic osteoarthropathy. The underlying mechanisms leading to these diseases are complex and not fully understood but are thought to be multifactorial. Radiology may play an important role in early diagnosis and treatment planning in this population, in whom clinical and laboratory findings are commonly equivocal and nonspecific. Although biopsy is often necessary for the final diagnosis, it is important for the radiologist to be familiar with the different types of musculoskeletal disease in HIV-positive and AIDS patients so that an appropriate differential diagnosis can be established. © RSNA, 2004
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Musculoskeletal infection is commonly encountered in the emergency department and can take many forms, depending on the involvement of the various soft-tissue layers, bones, and joints. Infection may manifest as superficial cellulitis, necrotizing or nonnecrotizing fasciitis, myositis, a soft-tissue abscess, osteomyelitis, or septic arthritis. Because clinical parameters for the detection of musculoskeletal infection generally lack sensitivity and specificity, computed tomography (CT) plays an important role in the assessment of potential musculoskeletal infections in the emergency department. CT provides an analysis of compartmental anatomy, thereby helping to distinguish among the various types of musculoskeletal infection and to guide treatment options. Specific imaging features exist that help identify the numerous forms of infection in the bones and soft tissues, and CT is invaluable for detecting deep complications of cellulitis and pinpointing the anatomic compartment that is involved by an infection. Although all patients with musculoskeletal infection will require treatment with antibiotics, CT helps guide therapy toward emergency surgical débridement in cases of necrotizing fasciitis and toward percutaneous drainage in cases of abscess formation. © RSNA, 2007
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