Findings
- Sagittal T2(1) showing thickening of the synovial lining of the median atlantoaxial that is well depicted in the axial T2(2). Reduced joint space with articular surface erosions and subarticular edema is also noted involving the bilateral atlantooccipital joints(3). Enlarged bilateral cervical lymph nodes also noted(3 and 6). Post contrast sagittal T2(4) and axial post contrast(5) images show enhancement of the synovial lining of the median atlantoaxial joint. Enhancement with synovial effusion also noted involving the bilateral atlantooccipital joints(6).
- Incidentally noted Nasopharyngal(Thornwaldt) cyst also noted(1 and 2).
Diagnosis
Septic arthritis of the median atlantoaxial and bilateral atlantooccipital joints.
Summary
Craniovertebral junction arthritis is an uncommon yet important differential in patients with neck pain/stiffness. Differentials include inflammatory and septic arthritis. In all MRI cervical spine scans, it is imperative to have a look at the craniovertebral junction. Apart from arthritis, at times, the anomalies can also be diagnosed which might be clinically silent initially but later on become symptomatic. If diagnosed in early course of disease, early management can aid in preserving the underlying cervicomedullary junction.
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