RESUMEN
BACKGROUND: Enthesopathy may lead to calcification of the stylohyoid ligament and can cause elongation of the styloid process (SP). OBJECTIVES: To evaluate whether SP elongation is associated with two common enthesitis-related diseases: ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). METHODS: Cervical spine computed tomography (CT) examinations of patients with DISH (n=64, Resnick criteria), AS (n=24, New York criteria) and a controls (no radiological signs of DISH or AS, n=54) were retrospectively evaluated. The DISH group was further divided into patients with and without cervical DISH. The length of right and left SP was measured independently by two readers on coronal and sagittal curved reformats. The average right and left styloid length and average length per person were compared among the groups. RESULTS: Demographic characteristics were similar between the DISH and control groups (average age 68.2 ± 15.7, 69.2 ± 12.7 years, male:female ratio 48:16 and 35:19, respectively, P > 0.05), whereas age was significantly lower (average age: 53 ± 15 years, P < 0.0001) in the AS group, which was also composed mainly of men. The AS and DISH groups had significantly longer SP compared to controls (AS 37.9 ± 9.6 mm, DISH 34.4 ± 9 mm, control 30.3 ± 10.1 mm, P < 0.05). There was no correlation between age and SP length. Inter-reader reliability of SP measurements was excellent in all groups (ICC = 0.998, P < 0.0001). CONCLUSIONS: SP elongation is associated with both AS and DISH substantiating the enthesopathy-related pathophysiology of this finding.
Asunto(s)
Entesopatía/complicaciones , Hiperostosis Esquelética Difusa Idiopática , Osificación Heterotópica , Espondilitis Anquilosante , Hueso Temporal/anomalías , Factores de Edad , Anciano , Calcinosis , Vértebras Cervicales/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/etiología , Ligamentos/patología , Masculino , Persona de Mediana Edad , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/etiología , Reproducibilidad de los Resultados , Factores de Riesgo , Factores Sexuales , Espondilitis Anquilosante/diagnóstico por imagen , Espondilitis Anquilosante/etiología , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
A 6 months old infant, diagnosed with a rare mutation causing severe hemophilia A, presented with spinal epidural hematoma. Parents later admitted the infant had glass cupping therapy performed within 2 weeks of the onset of symptoms. The rare mutation, rare bleeding complication, and the eventual course of therapy applied in this case will be discussed in our case report.