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Musculoskeletal manifestations of HIV infection

Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK

View larger version (91K): [in a new window]   Figure 1. Rectus femoris myositis. Comparison of axial sections through (a) the right and (b) the left thighs. Hyperreflectivity is seen in the rectus femoris muscle on the right, in keeping with early myositis.

View larger version (94K): [in a new window]   Figure 2. Escherichia coli muscle abscess and bacterial myositis. (a) Axial STIR and (b) coronal T1 weighted sections through the thighs in an iv drug injector. A focal abscess is shown in the right adductor magnus muscle, with marked swelling and oedema of the adductors. Gas is seen within the muscle (arrows) and cellulitis is shown in the adjacent subcutaneous fat. E. coli was isolated from the abscess.

View larger version (57K): [in a new window]   Figure 3. Tuberculous psoas abscess. (a,b) CT of the abdomen showing a low density abscess of the left psoas extending along the psoas muscle into the groin. Note the enhancing rim. Mycobacterium tuberculosis was grown from needle-aspirated fluid.

View larger version (139K): [in a new window]   Figure 4. Staphylococcus aureus septic arthritis of the left hip. The patient presented with left hip pain and fever. The initial film (a) was normal, with no evidence of effusion. 6 weeks later (b) there is periarticular osteoporosis and cortical destruction of the femoral head in keeping with septic arthritis. (c,d) MRI confirms septic arthritis with a tense joint effusion in the left hip and thickened synovium with T2 weighted hyperintensity on these STIR images (straight arrows). There is also bone marrow oedema in the roof of the acetabulum (curved arrow) and femoral head. (e,f) The same sections on T1 weighted post gadolinium images show intense enhancement of the synovium. There is also increased signal from the marrow of the acetabulum, suggesting early ostemyelitis.

View larger version (92K): [in a new window]   Figure 5. Tuberculous sacroiliac joint septic arthritis. (a) This patient presented with right buttock pain and sciatica. Note widening of the right sacroiliac (SI) joint (arrows). (b,c) CT confirms SI joint widening and demonstrates extensive abscess formation deep to the psoas and in the erector spinae and gluteus muscles. Note also the soft tissue thickening and oedema in the right sciatic notch (curved arrow). Axial (d)and coronal (e) STIR images show fluid within the right SI joint as well as bone marrow oedema in the adjacent sacrum and iliac bone. There is also extensive oedema in the gluteal muscles and subcutaneous fat.

View larger version (150K): [in a new window]   Figure 6. Staphylococcal discitis. (a) Saggital T1 weighted image of the lumbar spine shows destruction of the vertebral body endplates surrounding the L2/L3 disc (arrow). (b) T2 weighted section shows high signal within the disk and oedema in the surrounding vertebral bodies.

View larger version (132K): [in a new window]   Figure 7. Primary non-Hodgkin's lymphoma of muscle. An isointense T1 weighted (a), hyperintense STIR (b)dumb-bell shaped, homogeneous, well defined mass is seen in the forearm of this patient. The mass shows some enhancement post gadolinium injection. Axial T1 weighted (c) pre contrast medium and (d) post contrast medium injection.

View larger version (87K): [in a new window]   Figure 8. Primary non-Hodgkin's lymphoma of bone. (a) Plain radiograph shows sclerosis and periosteal reaction affecting the distal diaphysis and metaphysis of the right femur. (b) Sagittal STIR and (c) T1 weighted post gadolinium coronal MRI show irregular high signal periosteal thickening (b) and an ill-defined enhancing soft tissue mass (c).

View larger version (109K): [in a new window]   Figure 9. Bilateral avascular necrosis of the femoral heads. (a) The plain film shows slight flattening on the left. T1 weighted (b) and T2 weighted (c) MRI demonstrate the characteristic appearances of serpiginous alternating dark and bright lines deep to the articular cartilage. Note also some collapse of the femoral head on the left, with an associated joint effusion.

View larger version (136K): [in a new window]   Figure 10. Hypercellular marrow. Low signal on (a) T1 weighted and (b) T2 weighted MRI reflecting replacementof marrow by cellular elements.