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{{Hemophilia}}
{{Hemophilia}}
{{CMG}};{{AE}} {{Simrat}}
{{CMG}};{{AE}} {{Sab}}, {{Rohan}}


==Overview==
==Overview==
An x-ray of the joints in the case of hemophilic arthropathy may be helpful in the diagnosis of hemophilia. Findings on an x-ray suggestive of hemophilic arthropathy include synovial hypertrophy, joint effusion, cartilagenous degeneration.
An [[X-rays|x-ray]] of the [[Joint|joints]] in the case of [[Hemophilia|hemophilic]] [[arthropathy]] may be helpful in the [[diagnosis]] of hemophilia. Pettersson scoring system, designed in 1980, is widely applied for the [[classification]] of [[Bone|osteo]]-[[Cartilage|chondral]] changes of [[Hemophilia|hemophilic]] [[arthropathy]] in [[Elbow|elbows]], [[Knee|knees]], and [[Ankle|ankles]]. This scoring system is based on typical findings of [[Hemophilia|hemophilic]] [[arthropathy]] on [[Anatomical terms of location|posterior]]-[[Anatomical terms of location|anterior]] and [[lateral]] [[x-rays]]. Arnold-Hilgartner classification is also a [[Radiography|plain radiograph]] grading system for [[Hemophilia|hemophilic]] [[arthropathy]].
 
 
On knee x-ray, hemophilia is characterized by widening of the intercondylar notch, flattening of the condylar surface, or squaring of the [[patella]], are very characteristic of chronic hemarthrosis of the [[knee]].


==X Ray==
==X Ray==
Images reflect the presence of hemarthrosis (joint effusion), [[synovial]] inflammation and [[hyperemia]] ([[osteoporosis]] and epiphyseal overgrowth), chondral erosions and subchondral resorption (osseous erosions and cysts), [[cartilaginous]] denudation (joint space narrowing), [[intraosseous]] or [[subperiosteal]] hemorrhage (pseudotumors), and osseous proliferation (sclerosis and [[osteophytes]]).  
*An [[X-rays|x-ray]] of the [[Joint|joints]] in the case of [[Hemophilia|hemophilic]] [[arthropathy]] may be helpful in the [[diagnosis]] of hemophilia.
 
*Pettersson scoring system, designed in 1980 and based on typical findings of [[Hemophilia|hemophilic]] [[arthropathy]] on [[Anatomical terms of location|posterior]]-[[Anatomical terms of location|anterior]] and [[lateral]] [[x-rays]], is widely applied for the [[classification]] of [[Bone|osteo]]-[[Cartilage|chondral]] changes of [[Hemophilia|hemophilic]] [[arthropathy]].<ref name="pmid7408294">{{cite journal |vauthors=Pettersson H, Ahlberg A, Nilsson IM |title=A radiologic classification of hemophilic arthropathy |journal=Clin. Orthop. Relat. Res. |volume= |issue=149 |pages=153–9 |date=June 1980 |pmid=7408294 |doi= |url=}}</ref>
Some abnormalities of osseous shape, such as widening of the intercondylar notch, flattening of the condylar surface, or squaring of the patella, are very characteristic of chronic hemarthrosis of the knee.
{| align="right"
 
|
([http://www.radswiki.net Images courtesy of RadsWiki])
[[File:Xray Haemophilia.gif|300px|thumb|X-ray showing hemophilic arthropathy with moderate effusion, decreased joint space, subchondral erosions, and the physis is narrow compared to the other knee. The intercondylar notch is irregular and wide. .[https://radiopaedia.org/cases/haemophilic-arthropathy-2?lang=us#googDisableSync Source: Case courtesy of Dr Abdallah Al Khateeb , Radiopaedia.org, rID: 45521]]]
 
|}
<gallery>
'''Classification of hemophilic arthropathy according to the Pettersson score'''<ref name="pmid7408294">{{cite journal |vauthors=Pettersson H, Ahlberg A, Nilsson IM |title=A radiologic classification of hemophilic arthropathy |journal=Clin. Orthop. Relat. Res. |volume= |issue=149 |pages=153–9 |date=June 1980 |pmid=7408294 |doi= |url=}}</ref>
Image:Hemophilia-001.jpg|Hemophilic arthropathy involving the bilateral knees
{| style="border: 0px; font-size: 90%; margin: 3px; width:500px"
Image:Hemophilia-002.jpg|Hemophilic arthropathy involving the bilateral knees
| valign="top" |
Image:Hemophilia-003.jpg|Hemophilic arthropathy involving the bilateral knees
|+
Image:Hemophilia-004.jpg|Hemophilic arthropathy involving the bilateral knees
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Finding}}
</gallery>
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Interpretation}}
 
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |[[Osteoporosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Present = 1
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |Enlargement of [[epiphysis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Present = 1


<gallery>
|-
Image:Hemophilia_ankle_101.jpg|X-ray of the ankle in a patient with Hemophilia
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Irregularity of subchondral surface
Image:Hemophilia_ankle_102.jpg|X-ray of the ankle in a patient with Hemophilia
| style="padding: 5px 5px; background: #F5F5F5;" |
Image:Hemophilia_ankle_103.jpg|X-ray of the ankle in a patient with Hemophilia
*Absent = 0
</gallery>
*Partially involved = 1
*Totally involved = 2
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Narrowing of [[joint]] space
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Joint space > 1 mm = 1
*Joint space < 1 mm = 2
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Subchondral [[Cyst|cysts]] formation
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*1 cyst = 1
*>1 cyst = 2
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Erosion of [[joint]] margins
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Present = 1
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Gross incongruence of articulating [[bone]] ends
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Slight = 1
*Pronounced = 2
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |[[Joint]] deformity (angulation and/or displacement)
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Slight = 1
*Pronounced = 2
|-
|}


''' Arnold-Hilgartner scale of hemophilic arthropathy'''<ref name="pmid849938">{{cite journal |vauthors=Arnold WD, Hilgartner MW |title=Hemophilic arthropathy. Current concepts of pathogenesis and management |journal=J Bone Joint Surg Am |volume=59 |issue=3 |pages=287–305 |date=April 1977 |pmid=849938 |doi= |url=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width:450px"
| valign="top" |
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 330px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Stage 0
| style="padding: 5px 5px; background: #F5F5F5;" |
*Normal [[joint]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |Stage I
| style="padding: 5px 5px; background: #F5F5F5;" |
*No [[Skeleton|skeletal]] abnormalities
*[[Soft tissue|Soft-tissue]] [[Edema|swelling]] is present
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Stage II
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Osteoporosis]] and overgrowth of the [[epiphysis]]
*No [[Cyst|cysts]]
*No narrowing of the [[cartilage]] space
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Stage III
| style="padding: 5px 5px; background: #F5F5F5;" |
*Early subchondral [[bone]] [[Cyst|cysts]]
*Squaring of the [[patella]]
*Widened [[notch]] of the [[Femur|distal femur]] or [[humerus]]
*Preservation of the [[cartilage]] space
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Stage IV
| style="padding: 5px 5px; background: #F5F5F5;" |
*Findings of stage III, but more advanced; narrowed [[cartilage]] space
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Stage V
| style="padding: 5px 5px; background: #F5F5F5;" |
*Fibrous [[joint]] [[Contracture|contractures]]
*Loss of the [[joint]] [[cartilage]] space
*Extensive enlargement of the [[Epiphysis|epiphyses]] with substantial disorganization of the [[joint]]
|-
|}


<gallery>
Image:Hemophilia_knee_101.jpg|X-ray of the knee in a patient with Hemophilia
Image:Hemophilia_knee_102.jpg|X-ray of the knee in a patient with Hemophilia
</gallery>
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 17:47, 31 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2], Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[3]

Overview

An x-ray of the joints in the case of hemophilic arthropathy may be helpful in the diagnosis of hemophilia. Pettersson scoring system, designed in 1980, is widely applied for the classification of osteo-chondral changes of hemophilic arthropathy in elbows, knees, and ankles. This scoring system is based on typical findings of hemophilic arthropathy on posterior-anterior and lateral x-rays. Arnold-Hilgartner classification is also a plain radiograph grading system for hemophilic arthropathy.

X Ray

X-ray showing hemophilic arthropathy with moderate effusion, decreased joint space, subchondral erosions, and the physis is narrow compared to the other knee. The intercondylar notch is irregular and wide. .Source: Case courtesy of Dr Abdallah Al Khateeb , Radiopaedia.org, rID: 45521

Classification of hemophilic arthropathy according to the Pettersson score[1]

Finding Interpretation
Osteoporosis
  • Absent = 0
  • Present = 1
Enlargement of epiphysis
  • Absent = 0
  • Present = 1
Irregularity of subchondral surface
  • Absent = 0
  • Partially involved = 1
  • Totally involved = 2
Narrowing of joint space
  • Absent = 0
  • Joint space > 1 mm = 1
  • Joint space < 1 mm = 2
Subchondral cysts formation
  • Absent = 0
  • 1 cyst = 1
  • >1 cyst = 2
Erosion of joint margins
  • Absent = 0
  • Present = 1
Gross incongruence of articulating bone ends
  • Absent = 0
  • Slight = 1
  • Pronounced = 2
Joint deformity (angulation and/or displacement)
  • Absent = 0
  • Slight = 1
  • Pronounced = 2


Arnold-Hilgartner scale of hemophilic arthropathy[2]

Stage Findings
Stage 0
Stage I
Stage II
Stage III
Stage IV
  • Findings of stage III, but more advanced; narrowed cartilage space
Stage V

References

  1. ↑ 1.0 1.1 Pettersson H, Ahlberg A, Nilsson IM (June 1980). "A radiologic classification of hemophilic arthropathy". Clin. Orthop. Relat. Res. (149): 153–9. PMID 7408294.
  2. ↑ Arnold WD, Hilgartner MW (April 1977). "Hemophilic arthropathy. Current concepts of pathogenesis and management". J Bone Joint Surg Am. 59 (3): 287–305. PMID 849938.

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