x-ray in rheumatology
DESCRIPTION
x-ray tutorialTRANSCRIPT
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X-Ray in RheumatologyX-Ray in Rheumatology
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1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Soft tissue swelling, uniform Soft tissue swelling, uniform
narrowing of joint spacenarrowing of joint space Subchondral bone cyst with sclerotic Subchondral bone cyst with sclerotic
rimrim C1-C2 subluxationC1-C2 subluxation DiagnosisDiagnosis Rheumatoid ArthritisRheumatoid Arthritis
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ผู้��ป่�วิยชาย ผู้��ป่�วิยชาย 16 16 ป่" ม'อาการป่วิดหล�งเร&�อร�ง ป่" ม'อาการป่วิดหล�งเร&�อร�ง 3 3 เด&อน เด&อน 1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Shiny corner sign of vertebraShiny corner sign of vertebra Early erosion of SIEarly erosion of SI DiagnosisDiagnosis Spondyloarthropathy, possible ASSpondyloarthropathy, possible AS
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ผู้��ป่�วิยชาย ผู้��ป่�วิยชาย 18 18 ป่" ม'อาการป่วิดห�วิแม%ม&อซั่�ายมา ป่" ม'อาการป่วิดห�วิแม%ม&อซั่�ายมา 1 1 ป่" ป่"
1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Soft tissue mass expansion of Soft tissue mass expansion of
proximal phalanxproximal phalanx Thinning and destruction of cortexThinning and destruction of cortex (suggest intra-osseous lesion)(suggest intra-osseous lesion) DiagnosisDiagnosis Pseudotumor form in hemophiliaPseudotumor form in hemophilia
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ผู้��ป่�วิยหญิ�ง ผู้��ป่�วิยหญิ�ง 6767 ป่" ป่วิดข้�อน��วิม&อ ป่วิดติ�นคอป่" ป่วิดข้�อน��วิม&อ ป่วิดติ�นคอ 1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Rt 1Rt 1stst CMC subluxation with CMC subluxation with
osteophyteosteophyte DiagnosisDiagnosis OA hand (DIP)OA hand (DIP)
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1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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DiagnosisDiagnosis OA spineOA spine OA HandOA Hand
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Case7Case7
ผู้��ป่�วิยหญิ�ง ผู้��ป่�วิยหญิ�ง 2222 ป่" ป่วิดข้�อม&อ ป่วิดข้�อน��วิม&อ ป่" ป่วิดข้�อม&อ ป่วิดข้�อน��วิม&อ 1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Joint space narrowing, erosive of Joint space narrowing, erosive of
carpal bonecarpal bone DiagnosisDiagnosis Rheumatoid arthritisRheumatoid arthritis
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ผู้��ป่�วิยหญิ�ง ผู้��ป่�วิยหญิ�ง 4141 ป่" ป่วิดหล�ง ป่วิดข้�อเข้%า ป่วิดข้�อป่" ป่วิดหล�ง ป่วิดข้�อเข้%า ป่วิดข้�อเท้�าเท้�า
1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Intervertebral bridgingIntervertebral bridging Articular surface irregularly Articular surface irregularly
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ผู้��ป่�วิยหญิ�ง ผู้��ป่�วิยหญิ�ง 4444 ป่" เหน&�อย ม&อเย)นเข้'ยวิเม&�อโดนป่" เหน&�อย ม&อเย)นเข้'ยวิเม&�อโดนอากาศเย)นอากาศเย)น
1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Scleroderma (acrosteolysis)Scleroderma (acrosteolysis) Scleroderma lungScleroderma lung
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Severe loose prosthetic jointSevere loose prosthetic joint Left hip prosthesis = soft tissue massLeft hip prosthesis = soft tissue mass
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FindingFinding SclerodactylySclerodactyly Joint space Joint space ด'ด' DiagnosisDiagnosis MCTD/SclerodermaMCTD/Scleroderma
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Case12Case12
ผู้��ป่�วิยหญิ�ง ผู้��ป่�วิยหญิ�ง 5858 ป่" เหน&�อย ป่วิดส�นเท้�า ป่วิดข้�อเท้�าป่" เหน&�อย ป่วิดส�นเท้�า ป่วิดข้�อเท้�า 1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Calcaneal spureCalcaneal spure Calcification of Achilles’s insertionCalcification of Achilles’s insertion Differential diagnosisDifferential diagnosis Degenerative processDegenerative process SNSASNSA
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DiagnosisDiagnosis Gouty arthritisGouty arthritis
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ผู้��ป่�วิยชาย ผู้��ป่�วิยชาย 47 47 ป่" ม'อาการป่วิดหล�งป่" ม'อาการป่วิดหล�ง 1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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ASAS
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ผู้��ป่�วิยชาย ผู้��ป่�วิยชาย 19 19 ป่" ม'อาการป่วิดหล�งป่" ม'อาการป่วิดหล�ง 1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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ASAS
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Erosive OA Rt 3Erosive OA Rt 3rdrd DIP DIP
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ผู้��ป่�วิยหญิ�ง ผู้��ป่�วิยหญิ�ง 7070 ป่" ป่วิดข้�อม&อ ป่วิดข้�อน��วิม&อ ป่" ป่วิดข้�อม&อ ป่วิดข้�อน��วิม&อ 2 2 ข้�างข้�าง
1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding OsteopeniaOsteopenia Punch out lesion Rt ulnar styloidPunch out lesion Rt ulnar styloid DiagnosisDiagnosis Gouty hand (mimic RA)Gouty hand (mimic RA)
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Case18Case18
ผู้��ป่�วิยชาย ผู้��ป่�วิยชาย 49 49 ป่" ม'อาการป่วิดกลางหล�งมากจนป่" ม'อาการป่วิดกลางหล�งมากจนติ�องติ&�นมากลางด,ก ไข้�ติ.�าๆ น.�าหน�กลดมา ติ�องติ&�นมากลางด,ก ไข้�ติ.�าๆ น.�าหน�กลดมา 2 2 เด&อนเด&อน
1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding T5 vertebra – heterogeneous density T5 vertebra – heterogeneous density
(permeative osteolytic lesion)(permeative osteolytic lesion) Disc space Disc space ป่กติ�ป่กติ� DiagnosisDiagnosis Infiltrative bone lesions suggestive of Infiltrative bone lesions suggestive of
tumor/metastasistumor/metastasis (Final diagnosis : Lymphoma)(Final diagnosis : Lymphoma)
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ผู้��ป่�วิยชาย ผู้��ป่�วิยชาย 73 73 ป่" ม'อาการป่วิดหล�งป่วิดเอวิมากมาป่" ม'อาการป่วิดหล�งป่วิดเอวิมากมา 4 4 เด&อน ไม%ม'ไข้�เด&อน ไม%ม'ไข้�
1.1. Describe findingDescribe finding
2. Diagnosis2. Diagnosis
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FindingFinding Multiple vertebral body collapse at T5, Multiple vertebral body collapse at T5,
T7, T8 (biconcave shape)T7, T8 (biconcave shape) Diffuse osteopeniaDiffuse osteopenia Dilatation of descending aortaDilatation of descending aorta
DiagnosisDiagnosis Osteoporosis with multiple compression Osteoporosis with multiple compression
fracturefracture Aortic aneurysmAortic aneurysm
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DiagnosisDiagnosis C spondylosisC spondylosis