Following renal transplantation and during long repeated hemodialysis, acute or chronic synovitis may supervene as a complication (Bravo et al. 1967). Generally, the articular inflammation is simple, but occasional infection has been reported (Spencer 1986). The physical irritation of denatured and fragmented articu
lar cartilage has been held to be responsible in some instances.
Soft-tissue radiography shows distension of the articular capsule and periarticular soft-tissue swelling when the process has run a chronic course or in the presence of infection (Fig. 8.7A) and bone technique radiography demonstrates articular narrowing with diffuse periarticular osteopenia (Fig. 8.7B).
The pinhole scan features are similar to those seen in other types of synovitis, although they are mild unless complicated by an infection. Once infection is present, pyarthrosis manifests as extremely intense tracer uptake with a narrowed joint, which looks like a joint "in flame" (Fig. 8.7C). Interestingly, whole-body bone scintigraphy, a necessary imaging in bone scanning, demonstrates systemic low skeletal uptake with the absence of kidney uptake, denoting osteoarthropathy secondary to chronic renal failure (Fig. 8.7D).
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