INTERACTIVE MODULE · WALKTHROUGH

How a RheumaView challenge works

Challenge #17 · 8 plain films
2 staged reads · scored & explained
RHEUMAVIEW™ CHALLENGE #17

Before the words came.

The disease spoke before she did.

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RheumaView case — English
English

Read the films

Eight plain radiographs — no history, no labs. Open any film to zoom in and scroll the series.

AP coned sacroiliac / pelvis
AP thoracolumbar / lumbar spine
AP lumbar (alternate)
Left posterior oblique SI
Right posterior oblique SI
AP lumbar (rotated)
Lateral lumbar spine
Coned lateral lumbosacral / coccyx
Look at them without bias — what do they actually show?

Stage 1 · Real findings

Attempt 1 of 3

Pick the 5 most important findings.

✓
Bowel gas and stool overlying the pelvis — technical, mildly limits some detail.
✓
Bilateral sacroiliitis — shallow marginal erosions + iliac-side subchondral sclerosis.
✓
Bilateral mNY grade II structural pattern — inflammatory in origin, not degenerative.
✓
Mild lower-lumbar disc-space narrowing — minor degenerative change, lower priority.
✓
Left-sided lumbosacral transitional anatomy with pseudoarticulation (Bertolotti-type).
✓
Smooth anterior coccygeal angulation — developmental, not an acute fracture.
✓
No SI joint ankylosis — early / mild stage; reversibility window still open.
✓
Vertebral body heights preserved — no wedge or compression deformity.
✓
No syndesmophytes, no vertebral squaring, no bamboo spine.
✓
Pubic symphysis intact — no symphyseal widening or erosion.
Picks: 0 / 5

Stage 1 · Real findings

Attempt 1 of 3
Each attempt re-scores instantly. Reach 3 of 5 to advance.

Stage 1 · Final attempt

Attempt 3 of 3

Heatmap hint enabled — each region lights up as you find what lives there.

Where the key findings live

Sacroiliac joints0 / 3NONE YET
Lumbosacral junction / transitional anatomy0 / 1NONE YET
Vertebral column (pattern absences)0 / 1NONE YET
Red → amber → green as each region is satisfied.

Stage 1 cleared

5 of 5 key findings caught — every finding belongs in the report.

465 / 465
Diagnosis reframe✓ You picked this+100 pts
Bilateral sacroiliitis — shallow marginal erosions + iliac-side subchondral sclerosis, predominantly inferior.
Why this matters

Bilateral, iliac-side sclerosis with shallow erosions in an inferior distribution is an inflammatory pattern — not mechanical wear, and not osteitis condensans.

Diagnosis reframe✓ You picked this+95 pts
Bilateral mNY grade II structural pattern — inflammatory in origin, not degenerative.
Pain generator✓ You picked this+95 pts
Left-sided lumbosacral transitional anatomy (Bertolotti-type) — a separate mechanical contributor.
Pertinent negative✓ You picked this+90 pts
No SI ankylosis, no bony bridging — early / mild stage; reversibility window is open.
Pertinent negative✓ You picked this+85 pts
No syndesmophytes, no vertebral squaring, no bamboo-spine pattern.
+ Other valid findings. Five more correct observations are recognised and listed as “correct · not in your top 5” — each expandable for the reasoning, just like the key findings above.
Open any card to read the reasoning.

Stage 2 · Misreads to avoid

Attempt 1 of 3

Mark the 5 misreads that would harm this patient if written into the report.

✓
"Degenerative changes only — bilateral SI sclerosis reflects mechanical wear."
✓
"Bilateral inferior sacroiliac erosive change with iliac-side sclerosis." (real finding — keep)
✓
"DISH pattern — paraspinal sclerosis with sacroiliac changes."
✓
"Vertebral body heights are maintained; no compression deformity." (keep)
✓
"Findings are non-specific; only MRI can establish a diagnosis. Recommend MRI first."
✓
"No syndesmophytes or flowing anterior ossification." (keep)
✓
"Normal for age — a woman ~30 isn't the population for plain-film sacroiliitis."
✓
"Sacrococcygeal articulation is intact." (keep)
✓
"All findings are explained by the lumbosacral pseudoarticulation."
✓
"Pubic symphysis is preserved, without erosive symphysitis." (keep)
+460− 50= 410 pts

Stage 2 · Final attempt

Attempt 3 of 3

Misread traps — each clears to green only when caught

Age / sex dismissalNONE YET
Degenerative-relabelNONE YET
DISH misclassificationNONE YET
Deferral-to-MRINONE YET
Single-diagnosis-explains-allNONE YET
All 5 traps cleared — penalties avoided.

Case complete

🦅 RheumaView Eye
10 of 10 key findings caught
0 / 925
Final score
How you scored
Stage 1 (positive only): 465 / 465 — no penalty
Stage 2 (penalty mode): 410 / 460 — −50 cumulative penalty
TOTAL: 875 / 925

Your draft report

Findings you caught are highlighted; the ones you missed appear as plain text.

Both sacroiliac joints show shallow marginal erosive irregularity with iliac-side sclerosis, predominantly inferior — well spotted. The morphology and bilateral distribution are characteristic of a structural inflammatory pattern compatible with modified New York grade II sacroiliitis — sharp eye, rather than mechanical change. There is a left-sided lumbosacral transitional segment with pseudoarticulation (Bertolotti-type) — got it. The joint spaces remain visible: no ankylosis, early / mild stage, reversibility window open — you saw this, with no syndesmophytes or bamboo-spine pattern — nice catch.
Impression: bilateral structural sacroiliitis (mNY grade II) coexisting with left-sided lumbosacral transitional anatomy. No ankylosis, no fracture, no DISH.

Post-visit summary

  • HLA-B27 positive. MRI confirmed mild chronic sacroiliitis with active inflammation. Diagnosis: axial spondyloarthritis.
  • The history changed after the diagnosis. Family history and forgotten episodes emerged on second asking — recall is shaped by knowing.
  • MRI missed the Bertolotti anatomy. Twice. A more sensitive modality does not protect against a structured blind spot.
  • One year on treatment: full clinical remission, no radiographic progression, no active inflammation. The early window held.
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