radio-imagistica sistemului osteo-articular
TRANSCRIPT
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Radio-imagistica sistemului Radio-imagistica sistemului osteo-articularosteo-articular
Rad./imag-Iasi-1999-2003Rad./imag-Iasi-1999-2003
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METODE RADIO-IMAGISTICE
•RADIOGRAFIA STANDARD/DIGITALA;
•TOMOGRAFIA PLANA ;
•ULTRASONOGRAFIA=>P.MOI ARTICULARE
•CT;
• IRM;
•SCINTIGRAMA OSOASA;
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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ANATOMIEANATOMIE
RADIOLOGICARADIOLOGICA:
STRUCTURA
HAVERSIANA
NORMALA
Rad./imag-Iasi-1999-2003Rad./imag-Iasi-1999-2003
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CT-VERTEBRO
DISCALA:
Hernie de disc
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CT RECON.3 DCT RECON.3 D
COL.VERTEBRALA.
ART.GENUNCHI
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IRM:IRM:STUDIUL ARTICULATIEI COXO-FEMURALESTUDIUL ARTICULATIEI COXO-FEMURALE
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IRM:IRM: STUDIUL COL.VERTEBRALE & CANAL RAHIDIANSTUDIUL COL.VERTEBRALE & CANAL RAHIDIAN
T 1 T 2
SAGITAL
Hernie discala
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IRM:: PUMN CORONAL(A)PUMN CORONAL(A)
GENUNCHI SAGITAL(B)GENUNCHI SAGITAL(B)
A B
Focar de necroza in scafoid
menisc
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SEMEIOLOGIE SEMEIOLOGIE RADIOLOGICA OSOASARADIOLOGICA OSOASA
I.MODIFICARI STRUCTURALEI.MODIFICARI STRUCTURALE
1.REZORBTIA:1.REZORBTIA: - -osteoporozaosteoporoza
-osteoliza-osteoliza
-osteonecroza-osteonecroza
2.OSTEOCONDENSAREA(OSTEOSCLEROZE):2.OSTEOCONDENSAREA(OSTEOSCLEROZE):
-PERIOSTOZA-PERIOSTOZA
-ENDOSTOZA-ENDOSTOZA
-SPONGIOSCLEROZA-SPONGIOSCLEROZARad./imag-Iasi-1999-2003Rad./imag-Iasi-1999-2003
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SEMEIOLOGIE RADIOLOGICA: OSTEOPOROZA PATATA
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TOMOGRAFIE PLANA OSTEOLIZA CIRCUMSCRISA,cu lizereu extern de scleroza:
CHIST OSOS ESENTIAL
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METODE IMAGISTICE
•RADIOGRAFIA STANDARD/DIGITALA;
•TOMOGRAFIA PLANA ;
•ULTRASONOGRAFIA=>P.MOI ARTICULARE
•ARTROGRAFIA CU CONTRAST IODAT;
•CT;
• IRM;
•SCINTIGRAMA OSOASA;
•ARTERIOGRAFIA…==>RAD.INTERVENTIONALA
•PUNCTIA -BIOPSIE GHIDATA IMAGISTIC.
•RADIOGRAFIA STANDARD/DIGITALA;
•TOMOGRAFIA PLANA ;
•ULTRASONOGRAFIA=>P.MOI ARTICULARE
•ARTROGRAFIA CU CONTRAST IODAT;
•CT;
• IRM;
•SCINTIGRAMA OSOASA;
•ARTERIOGRAFIA…==>RAD.INTERVENTIONALA
•PUNCTIA -BIOPSIE GHIDATA IMAGISTIC.
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OSTEOPOROZA:STUDIU COMPARATIV PE RADIOGRAFIE STANDARD.
NORMAL
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NECROZA ASEPTICA A CALCANEULUI-EVOLUTIE
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OSTEOLIZA VERTEBRALA
(metastaze osoase)
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SEMEIOLOGIE OSOASA
II.II.MODIFICARI DE ORGANOGENEZAMODIFICARI DE ORGANOGENEZA::
-hiperostoza-hipostoza-hiperostoza-hipostoza
-oedostoza-oedostoza
-scoliostoza-scoliostoza
-hiperplazie-hipoplazie-hiperplazie-hipoplazie
-aplazie-agenezie-aplazie-agenezie
DISTROFIIDISTROFII
DISPLAZIIDISPLAZII
Rad./imag-Iasi-1999-2003Rad./imag-Iasi-1999-2003
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SEMEIOLOGIE RADIOLOGICA: osteoporoza, osteocondensare,scoliostoza, oedostoza
RAHITISM FLORID PSEUDARTROZA
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SEMEIOLOGIE:
SCOLIOSTOZA,
OSTEOPOROZA,
OSTEOSCLEROZA
(remaniere complexa)
BOALA PAGET
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PATOLOGIE OSOASAPATOLOGIE OSOASA
•TRAUMATISME:-fracturi, luxatii, entorse;
•BOLI INFLAMATORII:acute, cronice; osteite, osteomielite;
•TUMORI: benigne; potential maligne; maligne: primitive, metastatice
•NECROZE ASEPTICE
•DISPLAZII; DISTROFII
Rad./imag-Iasi-1999-2003Rad./imag-Iasi-1999-2003
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PATOLOGIEPATOLOGIE OSTEO-ARTICULARA OSTEO-ARTICULARA
AFECTIUNI ARTICULARE ACUTE:
-nesupurate=>RAA
-supurate=>artrite (stafilo/streptococ);
AFECTIUNI ARTICULARE CRONICE:
-nesupurate: PR, SA, artroze, metabolice, neuropatice;
-supurate: tbc.
Rad./imag-Iasi-1999-2003Rad./imag-Iasi-1999-2003
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OSTEOMIELITA
•ETIOLOGIE:ETIOLOGIE: stafilococ auriu,stafilococ auriu, streptococ;streptococ;
•MECANISM:MECANISM: -- embol microbianembol microbian in in artartera era nutritiva;nutritiva;
-- contiguitate (fracturi deschise,contiguitate (fracturi deschise, artrite etc);artrite etc);
•SEDIU: SEDIU: -- os lung=>metafize (debut);os lung=>metafize (debut);
-- extenzie diafizara,extenzie diafizara, epifizara,epifizara, articulara;articulara;
-- monostica,monostica, monotopa:monotopa: tibie,tibie, femur cca 75%.femur cca 75%.
Rad./imag-Iasi-1999-2003Rad./imag-Iasi-1999-2003
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OSTEOMIELITAOSTEOMIELITA
ASPECTE RADIOLOGICEASPECTE RADIOLOGICE
•DEBUT:DEBUT: osteoporoza localizata metafizar;osteoporoza localizata metafizar; dg.dificil=>IRM,dg.dificil=>IRM,
scintigrafie polinucleare marcate Ga-67;scintigrafie polinucleare marcate Ga-67;
STARESTARE::-osteoliza “patata”;-osteoliza “patata”;
-tumefactie de parti moi;-tumefactie de parti moi;
-necroza septica=>halou + sechestre;-necroza septica=>halou + sechestre;
-periostita=>mansoane,-periostita=>mansoane, grosiera,grosiera, extenzie diafizara;extenzie diafizara;
-abces subperiostal;-abces subperiostal;
-fistulizare in partile moi periosoase.-fistulizare in partile moi periosoase.
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OSTEOMIELITA ACUTA: DEBUT=>STARE
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OSTEOMIELITA:
EXTENZIA
DIAFIZO-METAFIZARA
Reactie periostala si abces subperiostic
Focar de osteoliza metafizar
PAPROFIL
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CT,RECONSTRUCTIE 3 D:CT,RECONSTRUCTIE 3 D:
OSTEOMIELITAOSTEOMIELITA
Geoda +sechestru
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OSTEOMIELITA
EVOLUTIE:-VINDECARE=>cicatrici fibroscleroase,geode;
-reactivare==>CRONICIZARE:domina reactia
endosteala / periosteala; focare osteolitice mici, sechestre mici;
COMPLICATII:-artrita supurata=>anchiloze ;
-fracturi=>scurtari de os;
-tulb.de crestere (adolescent):scoliostoza,hiper-plazii unilaterale de membru;
-septico-pioemie:abcese viscerale secundare;
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OSTEOMIELITA
SUGARULUI:
EVOLUTIE
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Osteomielita
cronica,in puseu
de acutizare:
microgeode,
micro-sechestre
Radiografie standard Tomografie plana
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OSTEOMIELITA CRONICA; DEFORMARI
Geoda= reactivare
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OSTEOMIELITA:
COMPLICATII:
artrita sold,necroza
capului femural,
subluxatie coxo-fem.
secundara,tulb.de
crestere femur.
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OSTEITA/MIELITA POST -INTERV.CHIRURGICALA (fractura)
Reactie
periostala osteoliza
Tija centromedulara
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OSTEOMIELITA
FFORME PARTICULARE
ABCES OSOS CENTRALABCES OSOS CENTRAL (BRODIE):
-SEDIU: tibie, metafiza superioara;
-ASPECT Rx:-geoda ovala, inel scleroza; fara sechestre/r.periostala
-EVOLUTIE: cronica, cu pusee de acutizare.
PANARITIU OSOS (osteita / osteomielita=>contiguitate de la p.moi)
-SEDIU:-falange terminale
-ASPECT RADIOLOGIC:-liza osoasa din afara spre canal medular;
-fara reactie periostala.
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PANARITIU OSOS: EVOLUTIE NEFAVORABILA
Osteoliza falangeta
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TUMORI OSOASEBENIGNE BENIGNE PRIMAREPRIMARE MALIGNE PRIMAREMALIGNE PRIMARE
OSTEOM OSTEOM OSTEOSARCOMOSTEOSARCOM
FIBROM FIBROM FIBROSARCOM FIBROSARCOM
HEMANGIOM HEMANGIOM ANGIOSARCOMANGIOSARCOM
CONDROM CONDROM CONDROSARCOMCONDROSARCOM
T.MIELOPLAXE T.MIELOPLAXE SARCOM MEDULARSARCOM MEDULAR
-EWING;-EWING;
-JAKSON-PARKER-JAKSON-PARKER
MIELOMMIELOM
MALIGNE SECUNDARE: MALIGNE SECUNDARE: metastaze,metastaze, leucemii,leucemii, limfoamelimfoame
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OSTEOMORIGINE:ORIGINE: Tesut osos adult, supercompact, benign.Tesut osos adult, supercompact, benign.
CLINIC: CLINIC: lent evolutiv;lent evolutiv; nu metastazeazanu metastazeaza !!
SEDIU: SEDIU: sinus frontal, oase craniene.sinus frontal, oase craniene.
ASPECT RADIOLOGIC: ASPECT RADIOLOGIC: osteocondensat, compact, intens opac, osteocondensat, compact, intens opac, omogen, oval / rotund, contur policiclic;omogen, oval / rotund, contur policiclic;
DG.DG. DIFERENTIAL: DIFERENTIAL: meningiom osteoplastic.meningiom osteoplastic.
VARIANTAVARIANTA:: OSTEOMUL OSTEOIDOSTEOMUL OSTEOID=>unii anat.patologi =>unii anat.patologi sustin ca este o displazie sau osteita cronica si nu tumora…!sustin ca este o displazie sau osteita cronica si nu tumora…!
SEDIUSEDIU: diafiza os lung: diafiza os lung
ASPECT: ASPECT: focar osteolitic 4-10 mmfocar osteolitic 4-10 mm (NIDUS)(NIDUS), cu sechestru mic , cu sechestru mic central; hiperostoza / scleroza in jur, bombeaza subperiostal, in central; hiperostoza / scleroza in jur, bombeaza subperiostal, in partile moi.partile moi.
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OSTEOM DE SINUS FRONTAL
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FIBROM
ORIGINE: Tesut conjunctiv neosificat-intraosos
SEDIU:-metafiza / diafiza oaselor lungi
-mandibula=>”epulis”
ASPECT RADIOLOGIC:-zona osteolitica, cu inel net de scleroza in jur;
-contur ciclic
-osul adiacenr nemodificat
-fara reactie periostala.
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OSTEOFIBROM EXTREMITATE
INFERIOARA FEMUR
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TUMORI OSOASE BENIGNE
FIBROM OSOSFIBROM OSOS CHIST OSOS ESENTIALCHIST OSOS ESENTIAL
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HEMANGIOM
ORIGINE: VASCULARA; BENIGNA.
HISTO.PAT.: tip capilar, tip cavernos
SEDIU:-CRANIU- tip capilar; VERTEBRE- tip cavernos;
ASPECTE RADIOLOGICE:
-Tip capilar=osteoliza, rotunda, circumscrisa de inel opac, cu septuri opace radiare (“spite de roata”)
-Tip cavernos:-vertebra modificata ca structura (fagure, palisada, grilaj), forma (turtire cranio-podala,”butoi”); discuri vertebrale intacte; SE COMPLICA CU FRACTURA INTRASPONGIOASA/ INFUNDARE=VERTEBRA PLANA (CALVÈ).
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HEMANGIOM CAVERNOS VERTEBRAL
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OSTEOCONDROM
ORIGINE: TESUT CARTILAGINOS NEOSIFICAT
SEDIU: oase tubulare: falange, matacarpiene
TIPURI: -central = encondrom
-periceric = eccondrom
ASPECTE RADIOLOGICE:-lacuna ovalara, net delimitata,
cu inel fin de sleroza periferica; absenta reactiei periostale.
Condroame multiple = boala Ollier
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CONDROAME MULTIPLE-BOALA OLLIER
ECCONDROM
ENCONDROM
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EncondromEncondromEncondromEncondrom
radiografieradiografie IRM,T 1/T 2,CORONALAIRM,T 1/T 2,CORONALA
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T1T1
T2T2
OsteocondromOsteocondrom
radiografie IRM,SECT.AXIALA
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TUMORA CU MIELOPLAXE(CELULE GIGANTE)
SEDIU: epifiza oase lungi(tibie, femur), os plat.
ASPECTE RADIOLOGICE:-zona osteolitica cu septuri fine, (“bule de sapun”), bombare periostica epifizo-metafizara,
-aspect multiloculat, contur net corticala subtiata dar vizibila, aspect de “os suflat”
EVOLUTIE: -PUSEE OSTEOLITICE=>septurile se subtiaza/ raresc, dispar; corticala poate fi lizata complet pe alocuri; tumora se extinde in partile moi; degenerescenta maligna.
DG. DIFERENTIAL: -mielom solitar, encondrom, chist osos esential
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TUMORA CU MIELOPLAXE
EXTREMITATEA SUPERIOARA TIBIE
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TUMORA
CU
MIELOPLAXE
omoplat
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T.MIELOPLAXE
SACRUM
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OSTEOSARCOMORIGINE: osteocit matur; monostic, monotop; agresiv, metastaze
TIPURI: osteolitic, osteoplastic
SEDIU: metafiza oaselor lungi; distruge corticala, invazie parti moi
ASPECT RADIOLOGIC: TIP OSTEOLITIC:- la debut- perferic sau central; lacuna cu contur neregulat
-pinten sarcomatos CODMANN (“triunghiul mortii”)=reactia periostala limitata + decolarea periostului / distructie periostala;
TIP OSTEOPLASTIC: osteoliza + reactie periostala exuberanta, cu aspect radiar (“spiculi perpendiculari pe diafiza”,in perie”); respecta epifiza
EVOLUTIE:- METASTAZEAZA RAPID (pulmon, creier, ficat)
- fracturi patologice; invazia articulatiei vecine.
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OSTEOSARCOM:
TIPURI SI VARIANTE
RADIOLOGICE
OSTEOLITIC
CENTRAL PERIFERIC,RADIAR
OSTEOCONDENSANT
OSTEOLITIC
PERIFERIC
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-UL MORŢII
PINTENCODMANN
OSTEOSARCOM OSTEOLITIC FEMUR,
VARIANTA PERIFERICA
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OSTEOSARCOM EXTINS LOCO-REGIONAL(fractura)
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OSTEOSARCOM
OSTEOPLASTIC:
DEBUT
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OSTEOSARCOM OSTEOPLASTIC RADIUS
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OSTEOSARCOM
PERIFERIC FEMUR
TIP RADIAR
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OSTEOSARCOM: CT EVALUEAZA EXTENZIA
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CONDROSARCOMORIGINE: tesut cartilaginos (..condrom..?); exostoze osteogenice (b. Ombredanne)
SEDIU: metafizele oaselor lungi, basin, coaste
ASPECT RADIOLOGIC: osteoliza + calcificari amorfe in masa tumorala; invazie de parti moi
FIBROSARCOM OSOSORIGINE: tesut conjunctiv; dg. diferential dificil (BIOPSIE !)
ASPECT RADIOLOGIC:
Tip central = osteoliza os lung;
Tip periferic = sarcom periostal (parostal)
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CHONDROSARCOM FEMURCHONDROSARCOM FEMURCHONDROSARCOM FEMURCHONDROSARCOM FEMUR
Osificare Osificare enchondralăenchondrală
Scintigrafie Tc99m pirofosfat
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ChondrosarcomChondrosarcomChondrosarcomChondrosarcom
RADIOGRAFIERADIOGRAFIE IRMN,T 1/T 2IRMN,T 1/T 2
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SARCOM PAROSTAL
-tumora de parti moi ;
-osteoliza marginala a compactei diafizare tibiale.
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SARCOM EWING
ORIGINE: SARCOM MEDULOGEN; reticulosarcom infantil
SEDIU: metafizo-diafizar, tibie, femur, coaste;
ASPECT RADIOLOGIC:-osteoliza central medulara
-uzura compactei din interior
-reactie periostala “in foi de bulb de ceapa” (mansoane fine, concentrice);
-”suflare”, “in butoi” a diafizei (OEDOSTOZA).
EVOLUTIE: -metastazeaza in acelasi os si in alte oase, in viscere.
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SARCOM EWING:SARCOM EWING:
SCHITASCHITA
Reactie periostala
”foi de ceapa”
osteolizaosteoliza
-zona de osteoliza centrala,ce distruge compacta dinspre canal;
-extenzie metafizo-diafizara;
-reactie perostala tipica,”in foi”-mansaoane fine suprapuse.
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SARCOM EWING
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SARCOM EWING FEMUR: RADIOGRAFIE DIGITALA & CT
normal
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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RETICULOSARCOMUL JACKSON/PARKER
Pacient adult, afebril
SEDIU: diafiza os lung
ASPECT RADIOLOGIC: osteoliza diafizara + spongiozarea compactei=>uzura pe ambele fete
-osteoscleroza endostala + periostala anarhica, intrerupta, discontinua (“manson zdrentuit”);
-rar aspect spicular
EVOLUTIE: metastaze ganglionare, plamin
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RETICULOSARCOM JACKSON-PARKER TIBIE;
FRACTURA PE OS PATOLOGIC
Largire canal,osteoliza fibrilara a compactei;fractura sec.
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RETICULOSARCOAME
Coasta 10
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
ractura pe os patologic
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MIELOM (PLASMOCITOM)
ESTE CEA MAI FRECVENTA TUMORA MALIGNA PRIMARA A OSULUIORIGINE:-celule plasmocitare medulare (monoclonala) -marker: proteinurie BENCE JONES.SEDIU: -maduva hematogena=>adultTip multiplu => b. RUSTITKI-KHALERTip solitar => PLASMOCITOM (rara)ASPECT RADIOLOGIC:-zone osteolitice -aspect de “panou gaurit” (tipic la craniu)
-tasari vertebrale;coaste, os lung cu aspect suflat
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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MIELOM MULTIPLU; leziuni MIELOM MULTIPLU; leziuni
osteolitice craniu + CVosteolitice craniu + CV
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MIELOM MULTIPLU; leziuni osteolitice craniu + humerus
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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TUMORI MALIGNESECUNDARE
METASTAZE OSOASE (cancer osos metastatic)
CLINIC: cancer declarat / operat / ocult (cauta sin, prostata, pulmon, tiroida, rinichi etc).
LOCALIZARE: coloana vertebrala, basin, coaste.
TIPURI: OSTEOLITICE, OSTEOPLASTICE, MIXTE
OSTEOLITICE:-osteoliza progresiva: zone lacunare fara delimitare, fara reactie periostala
-fracturi secundare=>paraplegii, pareze etc.
OSTEOPLASTICE: -zone dense , patate (“pete de ceara” descrise de REBOUL), confluate; rare= cancerul prostatei, vezicii, sinului.
MIXTE:-alternanta liza / condensare pe aceleasi sedii topogr.
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TUMORI MALIGNE SECUNDARE
II.LEUCEMII;LIMFOAMEII.LEUCEMII;LIMFOAME
1)OSTEOPOROZA DIFUZA=>LEUCEMIA ACUTA(copil)
2)OSTEOSCLEROZA DIFUZA=>LEUCEMII CR.(adult)
3)LEZ.OSTEOLITICE VERTEBRALE=>INVAZIE DE LA
GANGLIONII RETROPERITONEALI =>ADENOPATIILE
DIN LIMFOAME MALIGTNE:VERTEBRA”DE IVORIU”
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METASTAZE OSOASE: A)OSTEOLITICE;B) OSTEOPLASTICE
A B
Cancer mamar Cancer prostatic
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METASTAZE OSTEOLITICE BASIN
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METASTAZE OSOASE OSTEOPLASTICE:pete de ceara (Reboul)
CANCER MAMAR T-4
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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NECROZE ASEPTICEMECANISM:-modificari ale vascularizatiei locale -post-traumatice -embolii gazoase (boala de cheson).
1)OSTEONECROZA CAPULUI FEMURAL=boala LEGG- CALVE-PERTHES):-distructie progresiva a capului fem.; spatiu articular pastrat, cavitate cotiloida normala
--evolutie spre anchiloza, subluxatie, coxartroza
2)OSTEONECROZA TIBIALA ANTERIOARA=boala OSGOOD SCHLATTER-LANELONG): -cioc, ”nas de tapir”, decolare si osteosinteza (realipire) sau detasare de fragment(“soricel..”).
3)VERTEBRALA=cifoscolioza juvenila (b. SCHEUERMANN)
-vertebre tasate, cuneiforme, scolioza, cifoza, hernii intraspongioase (noduli Schmorl), (platouri vertebrale ancosate)
-evolutie--spondilartroza precoce.
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NECROZA SEPTICA
NUCLEU DE CRESTERE
CAP FEMURAL
FRAGMENTARE
PULVERIZARE
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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NECROZA ASEPTICA A CAPULUI FEMURAL
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NECROZA ASEPTICA A CAPULUI FEMURAL:DEBUT
Forma adultuluiRad./imag-Iasi-2003Rad./imag-Iasi-2003
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NECROZA
ASEPTICA A
CAPULUI
FEMURAL:
TOMOGRAFIE
PLANA
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COMPUTER-COMPUTER-
TOMOGRAFIETOMOGRAFIE
NECROZA ASEPTICA
CAP FEMURAL
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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NECROZA ASEPTICA NECROZA ASEPTICA A CAPULUIA CAPULUI
FEMURAL; SECHELEFEMURAL; SECHELE:
SUBLUXATIESUBLUXATIE
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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NECROZA ASP\EPTICA A CRESTEI TIBIALE ANTERIOARENECROZA ASP\EPTICA A CRESTEI TIBIALE ANTERIOARE
(OSGOOD-SCHLATTER-LANELONG)(OSGOOD-SCHLATTER-LANELONG)
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NECROZANECROZA
ASEPTICA A ASEPTICA A
SCAFOIDULUISCAFOIDULUI
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
-osteoliza in fragmente, condensare reparatorie, cu resudarea unor fragmente; -deformarea scafoidului
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NECROZA ASEPTICANECROZA ASEPTICA
A CAPULUIA CAPULUI
CELUI DE-AL 2-LEACELUI DE-AL 2-LEA
METATARSIANMETATARSIAN
(KOHLER II)
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
-osteoliza fragmentata a epifizei distale metatarsian 2;-evazare a metafizei si diafizei,ingrosarea compactei prin reparatie ostocondensanta endoosoasa si periostala
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AFECTIUNI OSTEO-ARTICULARE
• ARTRITE SUPURATE-ACUTE
• OSTEO-ARTRITE CRONICE
-NESUPURATE
-SUPURATE:TBC
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ARTRITE SUPURATE
AG.ETIOLOGIC:-STAFILO,STREPTOCOC
MECANISM:SEPTICEMIE;CONTIGUITATE(OSTEOMIEL)
ASPECTE RX.:-sinovita:eco+IRMN;
-linia transparenta condro-articulara(dunga de doliu MENARD)
-osteoporoza difuza;ingustare interliniu;osteoliza epifizara;
-subluxatii;
DG.CERT:-punctie ac fin,ghidat fluoro/eco;aspiratie;antibiogr.
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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Geode pe capul humeral;epansament in articulatie (puroi)
puroi
geode
IRM(T-2)scapulo-humerala
Aspectul normalARTRITA SEPTICA SCAPULO-ARTRITA SEPTICA SCAPULO-
HUMERALAHUMERALA
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Artrite cronice nesupurate
1.SPONDILITA ANKILOZANTA(B.STRUMPEL-BECHTEREV)
DEBUT:sacro-iliac,periferic(genunchi),vertebral(C7-T1)
ASPECTE RX:DEBUT-ingustare,stergere,largire spatiu art.;-condensarea osului subchondral;-osteoporoza;
STARE -osificari ligamentare;-sindesmofite(ligam.perivertebrale anrtero-laterale);
TERMINAL(IV):-osificarea ap.ligamentar=>ANKILOZARE==> “bat de bambus”,”sina de tramvai”;-cifoza dorso-lombara larga=> “pozitia schiorului”;
-artrite/artroze/ankiloze a articulatiilor mari:coxo-fem.,genunchi.
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SPONDILITA ANKILOZANTA: SPONDILITA ANKILOZANTA: MODIFICARI SACROILIACE
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SPONDILITA ANKILOZANTA: SINDESMOFITE
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SPONDILITA ANKILOZANTA:SINDESMOFITE CERVICALE
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SPONDILITA ANKILOZANTA;EXTENZIE-artrita coxo-femurala; -anchiloza artrita/artroza sec.
sindesmofite
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Artrite cronice nesupurate2.POLIARTRITA REUMATOIDA.
CLINIC: -boala artritica cu teste inflamatorii pozitive
-etiologie incerta=> componenta autoimuna probabila.
DEBUT:-articulatii mici: interfalangiene, carpiene;-osteoporoza; largirea spatiului articular; chisturi, microgeode subchondrale pe epifize;
EVOLUTIE:-subluxatii falangiene, deviatii cubitale “in grifa”, ghiara, ”feuille au vent”;-ankiloza fibroasa / punti osoase interfalan-giene; osteoscleroza secundara
-extenzie la alte articulatii: picior, coxo-fememurala, genunchi etc.
SDR.CLINICE INCLUZIND P.R.: 1)Sdr.Still-Chaufard: copil, splenomegalie, adenopatii periferice, febra;2)Sdr.Felty: idem, adult; 3)Sdr. Reiter-Fiesenger-Leroy: PR, uretrita, conjunctivita (virala?); 4)Sdr. Kaplan-Colinet: PR +pneumoconioza;5)Sdr. Goujerot-Sjögren:PR.-artic.mari+uscare secr. salivare, lacrimale (xerostomie)
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POLIARTRITA
REUMATOIDA:
DEBUT/STARE
-osteoporoza dominant metafizo-epifizara si carpiana;-micro geode epifizare falangiene;-mici subluxatii interfalangiene;-ingustare a spatiilor articulare interfalangiene
Rad./imag-Iasi-2003Rad./imag-Iasi-2003
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POLIARTRITA REUMATOIDA:PERIOADA DE STARE
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POLIARTRITA REUMATIDA: STADIU AVANSAT
Mina “in grifa”
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POLIARTRITA REUMATOIDA: POLIARTRITA REUMATOIDA: mina in “ feuille au vent”mina in “ feuille au vent”
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ARTROZA DEFORMANTA
B. DEGENERATIVA-primitiva=>virsta 2-a, 3-a;-secundara:=> post-traumatica, necrotica, post-inflamatorie, metabolica etc.
ASPECTE RSDIOLOGICE:-ingustarea interliniului; scleroza subchondrala; modificari epifizare: ”slefuire”, dezrotunjire”;
-osteofitoza marginala: productii osoase spiculare pe insertii ligamentare, tendinoase=> “cioc de papagal”;
-osificari capsulare; fen de vacuum articular (vid-CT, IRM = fenomen descris de DITTMAR -FERGUSON = degenerescenta cartilagiului)
SEDII PREFERENTIALE:-coloana vertebrala (spondiloza
deformanta), sold (coxartroza), genunchi (gonartroza).
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SPONDILARTROZA DEFORMANTASPONDILARTROZA DEFORMANTA
-scleroza platourilor; -pensare spatiu discal;-osteofitoza
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SPONDILARTROZA DEFORMANTASPONDILARTROZA DEFORMANTA
osteofite
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IRM:IRM:MIELOPATIE CERVICARTROZICAMIELOPATIE CERVICARTROZICAIRM:IRM:MIELOPATIE CERVICARTROZICAMIELOPATIE CERVICARTROZICA
s. sagitales. sagitale Sectiune Sectiune axiala axiala
Lacuna medulara=siringomielie
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IRM :DiscartrozaIRM :DiscartrozaIRM :DiscartrozaIRM :Discartroza
Gadolinium IVTesutul inflamator capteaza contrastul paramagnetic
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ARTROZA DE GENUNCHI (“GONARTROZA”)
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IRM,T2:IRM,T2:Fisura menisc + chistFisura menisc + chist
IRM,T2:IRM,T2:Fisura menisc + chistFisura menisc + chist
Echo de spinEcho de spin
chist
-fragmentare meniscala; -hipersemnal de tip lichidian incapsulat=chist
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« Meniscoza« (artroza)« Meniscoza« (artroza)
MENISCUL
NORMAL
IRMIRM
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ARTROZA DE GENUNCHI:ARTROZA DE GENUNCHI:”VID ARTICULAR””VID ARTICULAR”
osteofiteRadiografie
marita direct
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ARTROZA AVANSATA
DE
GENUNCHI
(GONARTROZA)
-productii osoase peri/intraarticulare de tip osteofitic;-deformari ale epifizelor(rotunjire,scleroza subchondrala
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COXARTROZA IN STADIU AVANSAT (ANKILOZA)
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TUBERCULOZA OSTEO-ARTICULARA
MECANISM: reactivare BK in sinoviala articulatiilor mari =>adolescent, adult; ANAT.PAT.: osteoartrita supurata cronica.
ASPECTE RADIOLOGICE:
DEBUT: -osteoporoza regionala;-pensare spatiu articular;
STARE:-geode / carii osoase ”in oglinda” pe extremitatile articulare, osteoliza progresiva=>caverne epifizare, abcese reci articulare; EVOLUTIE: -prabusiri articulare;disparitia spatiului articular; topiri osteolitice”=>sechestre mici;-ankiloze;-blocuri articulare
FORME TOPOPGRAFICEFORME TOPOPGRAFICE
1).TBC VERTEBRALA=MORB POTT:-vertebre pereche;”fus” paravertebral (abces rece fuzat=>psoas);-bloc vertebral, cifoza;
2)COXITA (coxalgia): distructie cap femural si acetabul; anchiloza / protruzie in pelvis;
3)”TUMORA ALBA DE GENUNCHI: artrita, fistule, ankiloza.
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MORB POTT:LEZIUNI MINIMALE LOMBARE
-pensare spatiu discal; -ostoporoza;-geoda “in oglinda” pe platourile adiacente;-tendinta la sudare vertebrala(“bloc”)
LAT AP
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MORB POTT DORSAL: osteoliza, tasare, ”fus” paravertebral
Abces rece
PA LAT-sudare in “bloc vertebral”
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BLOC VERTEBRAL SECUNDAR MORBULUI POTTBLOC VERTEBRAL SECUNDAR MORBULUI POTT
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CT: MORB POTT
Abcesul“rece”
OSTEOLIZA
VERTEBRALA &
DISTRUCTIE
DISCALA
osteoliza
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COXITA TBC
(“COXALGIA”)
DEBUT / STARE
-osteoporoza marcata; -pensar/disparitia spatiului articular; -deformare litica a capului femural; -largirea cavitatii cotilului; -osteoliza a marelui trohanter.
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COXITA TBC: EVOLUTIE; COMPLICATII
Artroza/anchiloza Extenzie :focare ischio-pubiene
-fractura fundului acetabular ;-protruzie a capului femural in pelvis
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TUBERCULOZA GENUNCHIULUI : TUBERCULOZA GENUNCHIULUI : “TUMORA ALBA DE GENUNCHI”“TUMORA ALBA DE GENUNCHI”
geoda
cazeum calcificat
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TUBERCULOZA GENUNCHIULUI: TUBERCULOZA GENUNCHIULUI: “TUMORA ALBA DE GENUNCHI”“TUMORA ALBA DE GENUNCHI” ; ;LUXATIE SECUNDARALUXATIE SECUNDARA
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TUBERCULOZA COTULUI:PERIOADA DE STARE
OSTEOLIZA EPIFIZARA OLECRAN;osteoporoza
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TUBERCULOZA DE
PUMN
(RADIO-CARPIANA);
PERIOADA DE
STARE
-osteoliza extinsa la multiple oase carpiene;-distructie osteolitica si a epifizelor distale radius si cubitus; -tumefactie evidenta a partilor moi periarticulare;-osteoporoza marcata regionala.
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ALTE AFECTIUNI OSTEO-ARTICULARE
• HERNIA DISCALA;
• DISCARTROZA
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HERNIE DISCALA L-5/S-1HERNIE DISCALA L-5/S-1:RADIO.DIGITALA & CT.:RADIO.DIGITALA & CT.
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CT-VERTEBRO
DISCALA:
HERNIE
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IRM : Hernie discală IRM : Hernie discală IRM : Hernie discală IRM : Hernie discală
Protruzie discală focalăProtruzie discală focalăProtruzie discală focalăProtruzie discală focală
Sectiune axiala Sectiune sagitala
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Displazii osoaseDisplazii osoase
Sunt tulburari de crestere, osificare si dezvoltare a scheletului ce produc modificarea formei, structurii sau opacitatii scheletului. In functie de mecanismul de crestere perturbat,exista:
-displazii periostale- alterarea cresterii in grosime: Boala tip:-osteogeneza imperfecta letalis(b.Vrolick); -displazii encondrale- alterarea cresterii in lungime -prin deficit al cartilagiului de crestere si nucleilor epifizari: Boli tip:acondroplazia, boala Morquio
-displazii directionale- cartilajul de crestere se dezvolta in alt sens decit lungimea osului; boala tip:exostoze osteogenice (Boala Ombredanne)
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Displazii osoaseDisplazii osoase
Osteogeneza imperfecta-lipsa de opacitate a scheletului- corticala foarte subtire, canal medular largit, spongioasa lipseste/e foarte laxa-oase lungi gracile, subtiri (imagine de tub de sticla pe Rgf)-forma neonatala (b. Vrolik)- nou nascut-- diafiza oaselor lungi cu focare
de fractura consolidate vicios, nuclei de osificare normali-craniu in mozaic (lipsa de osificare a boltii), platispondilie-coaste subtiri, cu “matanii” datorita calusurilor
-forma tardiva (b. Lobstein)- surditate, fragilitate osoasa, sclere albastre-fracturi mai rare, oase lungi incurbate, epifize latite in paleta-platispondilie-oasele boltii craniului cu mineralizare retardata si incompleta-bazin- protruzie acetabulare, aripi iliace evazate
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Osteogeneza imperfecta letalis-Boala VROLICK-
Displazii osoaseDisplazii osoase
Oasele craniului subtiri,compacta redusa
Scoliostoze prin deficit de grosime/rezistenta a compactelor; fracturi “in lemn verde”;calusuri vicioase in utero
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Displazii osoaseDisplazii osoase
Osteogeneza imperfecta forma tardivă
-Boala LOBSTEIN-
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Displazii osoaseDisplazii osoaseAcondroplazia- apare la naştere--pitici cu membre scurte, cap mare, trunchi cu dezvoltare normala--oase lungi cu diafiza scurtă datorită lipsei de crestere în lungime
--metafize evazate brusc, epifize cu osificare întârziata,voluminoase, în ciuperca--femur-col scurt, gros, coxa vara; trohantere masive
-condili asimetrici, genu valg -cartilajul extremităţii inferioare-in accent circumflex
--lungimea tibiei egală cu a peroneului (peroneul pare să participe la articulaţia genunchiului)--bazin în inimă de carte de joc--scheletul miinii- scurt, ultimele 4 degete egale ca lungime (mînă în
trident)--craniu- oase frontale proeminente, amprente digitale--vertebre cuneiforme
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Displazii osoaseDisplazii osoase
Acondroplazia
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Displazii osoaseDisplazii osoase
Displazie spondilo-epifizara precoce (b. Morquio) -se observa la 2-4 ani--trunchi mic, gibus toraco-lombar, coaste aproape de bazin, craniu
normal--vertebre- platispondilie, vertebre insuficient dezvoltate anterior- cifoza
--platouri neregulate, discuri cu inaltime uşor crescuta--oase lungi— ramin scurte (osificare metafizara deficitara)
--nuclei epifizari dezvoltati în timp normal, neregulati, turtiti, prea mari / mici
-- metacarpiene 2-5 cu epifize distale conice / crenelateDIAGNOSTIC: sebazeaza pe:platispondilia generalizata + anomalii epifizare + eliminare urinara de keratosulfat
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Displazia spondilo-epifizara precoce
-Boala MORQUIO-
Displazii osoaseDisplazii osoasePLATISPONDILIE
Epifize turtite,nemodelate
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Displazii osoaseDisplazii osoase
Boala oaselor de marmura (osteopetroza, b. Albers-Schonberg)-familiala, ereditara-îngroşarea trabeculelor spongioasei, compactei cu sporire difuza a opacităţii scheletului;-canalul medular al oaselor lungi micsorat / disparut;-tesutul spongios cu densitate de compacta-striatii caracteristice în zonele de crestere: -benzi opace alternind cu benzi mai puţin opace,în metafiza oaselor lungi- aspect de brad;-oase iliace- benzi arciforme;-vertebre-2 zone dense spre platouri (vertebre” în sandwich”);-craniu voluminos, oasele boltii ingrosate;virsta osoasa normala, absenta calcificarilor in alte tesuturi;-fracturi frecvente
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Boala oaselor de marmura (b. Albers-Schonberg)
Displazii osoaseDisplazii osoase
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Boala PagetBoala PagetDistrofie a oaselor lungi si craniu cu evolutie cronică:-oase lungi- debut diafizar, cu decalcifierea (os cu aspect sters); -compacta se ingroasa prin apozitie periostala,remaniere spongioasa ( “se spongiozeaza”)= structura fibrilara cu trabecule groase. Oasele lungi se alungesc, se ingroasa, se curbeaza, apar fracturi.-craniu- creste in dimensiune--demineralizat, cu zone transparente---se condenseaza, oasele
boltii se ingroasa pe seama tabliei externe-vertebre- aspect scamosat, patat de atrofie hipertrofica, tutite
--vertebra cu chenar, vertebra de fildes-bazin- structura scamosata, vatoasa
--oasele sunt moi---deformare in inima de carte de joc
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Boala PagetBoala Paget
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