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Radio
-
imagistica sistemului
osteo
-
articular
UNIVERSITATEA “VASILE ALECSANDRI” BACAU FACULTATEA DE STIINTE ALE MISCARII, SPORTULUI SI SANATATIISTUDII UNIVERSITARE DE MASTERAT – SPECIALIZAREAKINETOTERPIA IN EDUCAREA SI REEDUCAREA FUNCTIONALADISCIPLINA: ELEMENTE DE IMAGISTICA
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METODE RADIO-IMAGISTICE
•RADIOGRAFIA STANDARD/DIGITALA;
•TOMOGRAFIA PLANA ;
•ULTRASONOGRAFIA=>P.MOI ARTICULARE•CT;
• IRM;
•SCINTIGRAMA OSOASA;
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ANATOMIE
RADIOLOGICA:STRUCTURA
HAVERSIANA
NORMALA
Rad./imag-Iasi-1999-2003
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CT-VERTEBRO
DISCALA:
Hernie de disc
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CT RECON.3 D
COL.VERTEBRALA.
ART.GENUNCHI
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IRM:STUDIUL ARTICULATIEI COXO-FEMURALE
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T 1 T 2
SAGITAL
Hernie discala
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IRM: PUMN CORONAL(A)
GENUNCHI SAGITAL(B)
A B
Focar de necrozain scafoid
menisc
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SEMEIOLOGIERADIOLOGICA OSOASA
I.MODIFICARI STRUCTURALE
1.REZORBTIA: -osteoporoza
-osteoliza
-osteonecroza
2.OSTEOCONDENSAREA(OSTEOSCLEROZE):
-PERIOSTOZA-ENDOSTOZA
-SPONGIOSCLEROZA Rad./imag-Iasi-1999-2003
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SEMEIOLOGIE RADIOLOGICA: OSTEOPOROZA PATATA
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TOMOGRAFIE PLANAOSTEOLIZACIRCUMSCRISA,cu lizereuextern 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.
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OSTEOPOROZA:STUDIU COMPARATIV PE
RADIOGRAFIE STANDARD.
NORMAL
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OSTEOLIZA VERTEBRALA
(metastaze osoase)
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SEMEIOLOGIE OSOASA
II.MODIFICARI DE ORGANOGENEZA:
-hiperostoza-hipostoza
-oedostoza-scoliostoza
-hiperplazie-hipoplazie
-aplazie-agenezieDISTROFII
DISPLAZII
Rad./imag-Iasi-1999-2003
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RAHITISM FLORID PSEUDARTROZA
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SEMEIOLOGIE:
SCOLIOSTOZA,OSTEOPOROZA,
OSTEOSCLEROZA
(remaniere complexa)BOALA PAGET
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PATOLOGIE 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-1999-2003
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OSTEOMIELITA
•ETIOLOGIE: stafilococ auriu, streptococ;
•MECANISM: -embol microbian in artera nutritiva;
- contiguitate (fracturi deschise, artrite etc);
•SEDIU: - os lung=>metafize (debut);
- extenzie diafizara, epifizara, articulara;
- monostica, monotopa: tibie, femur cca 75%.
Rad./imag-Iasi-1999-2003
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OSTEOMIELITAASPECTE RADIOLOGICE
•DEBUT:osteoporoza localizata metafizar; dg.dificil=>IRM,
scintigrafie polinucleare marcate Ga-67; STARE:-osteoliza “patata”;
-tumefactie de parti moi;
-necroza septica=>halou + sechestre;-periostita=>mansoane, grosiera, extenzie diafizara;
-abces subperiostal;
-fistulizare in partile moi periosoase.
OSTEOMIELITA ACUTADEBUT >STARE
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OSTEOMIELITA ACUTA:DEBUT=>STARE
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CT,RECONSTRUCTIE 3 D:
OSTEOMIELITA
Geoda +sechestru
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OSTEOMIELITAEVOLUTIE:-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
OSTEOMIELITA CRONICA; DEFORMARI
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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.
Tija centromedulara
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OSTEITA/MIELITA POST -INTERV.CHIRURGICALA (fractura)
Reactie
periostala osteoliza
Tija centromedulara
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OSTEOMIELITAFORME PARTICULARE
ABCES 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.mo
-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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OSTEOMORIGINE: Tesut osos adult, supercompact, benign.CLINIC: lent evolutiv; nu metastazeaza !SEDIU:sinus frontal, oase craniene.
ASPECT RADIOLOGIC:osteocondensat, compact, intens opac,omogen, oval / rotund, contur policiclic;DG. DIFERENTIAL:meningiom osteoplastic.
VARIANTA:OSTEOMUL OSTEOID=>unii anat.patologi sustinca este o displazie sau osteita cronica si nu tumora…! SEDIU: diafiza os lung
ASPECT: focar osteolitic 4-10 mm(NIDUS), cu sechestru miccentral; hiperostoza / scleroza in jur, bombeaza subperiostal, inpartile 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 descleroza in jur;
-contur ciclic
-osul adiacenr nemodificat
-fara reactie periostala.
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OSTEOFIBROM
EXTREMITATEINFERIOARA FEMUR
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TUMORI OSOASE BENIGNE
FIBROM OSOS CHIST 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 septuropace radiare (“spite de roata” )
-Tip cavernos:-vertebra modificata ca structura (fagure, palisada,grilaj), forma (turtire cranio-podala,”butoi”); discuri vertebraleintacte; 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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Encondrom
radiografie IRM,T 1/T 2,CORONALA
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T1
T2
Osteocondrom
radiografie IRM,SECT.AXIALA
TUMORA CU MIELOPLAXE
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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 ososesential
TUMORA CU
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TUMORA CUMIELOPLAXE
EXTREMITATEA
SUPERIOARA TIBIE
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TUMORACU
MIELOPLAXE
omoplat
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T.MIELOPLAXE
SACRUM
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OSTEOSARCOMORIGINE: osteocit matur; monostic, monotop;agresiv, metastazeTIPURI: osteolitic, osteoplastic
SEDIU: metafiza oaselor lungi; distruge corticala, invazie parti mo
ASPECT RADIOLOGIC: TIP OSTEOLITIC:- la debut- perfericsau central; lacuna cu contur neregulat
-pinten sarcomatos CODMANN (“triunghiul mortii”)=reactiaperiostala limitata + decolarea periostului / distructie periostala;
TIP OSTEOPLASTIC:osteoliza +reactie periostala exuberanta, cuaspect radiar (“spiculi perpendiculari pe diafiza”,in perie”);respecta epifizaEVOLUTIE:- METASTAZEAZA RAPID(pulmon, creier, ficat)
- fracturi patologice;invazia articulatiei vecine.
OSTEOCONDENSANT
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OSTEOSARCOM:
TIPURI SIVARIANTERADIOLOGICE
OSTEOLITICCENTRAL PERIFERIC,RADIAR
OSTEOCONDENSANT
OSTEOLITICPERIFERIC
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-ULMORŢII
PINTENCODMANN
OSTEOSARCOMOSTEOLITIC 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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CONDROSARCOM ORIGINE: tesut cartilaginos (..condrom..?); exostoze osteogenice (bOmbredanne) SEDIU: metafizele oaselor lungi, basin, coaste ASPECT RADIOLOGIC:osteoliza + calcificari amorfe in masatumorala; invazie de parti moi
FIBROSARCOM OSOSORIGINE: tesut conjunctiv; dg. diferential dificil (BIOPSIE !)ASPECT RADIOLOGIC:
Tip central = osteoliza os lung;
Tip periferic = sarcom periostal (parostal)
Scintigrafie Tc99m pirofosfat
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CHONDROSARCOM FEMUR
Osificare enchondrală
g p
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Chondrosarcom
RADIOGRAFIE IRMN,T 1/T 2
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SARCOM PAROSTAL-tumora de parti moi ;
-osteoliza marginala a
compactei diafizaretibiale.
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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:
SCHITA
Reactie periostala”foi de ceapa”
osteoliza
-zona de osteoliza centrala,cedistruge compacta dinspre canal;
-extenzie metafizo-diafizara;-reactie perostala tipica,”in foi” -mansaoane fine suprapuse.
SARCOM EWING
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SARCOM EWING FEMUR : RADIOGRAFIE DIGITALA & CT
normal
Rad./imag-Iasi-2003
RETICULOSARCOMUL
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RETICULOSARCOMULJACKSON/PARKER
Pacient adult, afebril
SEDIU: diafiza os lung
ASPECT RADIOLOGIC:osteoliza diafizara + spongiozareacompactei=>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 fibrilaraa compactei;fractura sec.
RETICULOSARCOAME
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Coasta 10
Rad./imag-Iasi-2003
ractura pe os patologic
MIELOM (PLASMOCITOM)
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MIELOM (PLASMOCITOM)
ESTE CEA MAI FRECVENTA TUMORA MALIGNAPRIMARA 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 aspectsuflat
Rad./imag-Iasi-2003
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MIELOM MULTIPLU; leziuni
osteolitice craniu + CV
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MIELOM MULTIPLU; leziuniosteolitice craniu + humerus
Rad./imag-Iasi-2003
TUMORI MALIGNE
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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 faradelimitare, fara reactie periostala
-fracturi secundare=>paraplegii, pareze etc.OSTEOPLASTICE: -zone dense , patate (“pete de ceara” descrisede REBOUL), confluate; rare= cancerul prostatei, vezicii, sinului.
MIXTE:-alternanta liza / condensare pe aceleasi sedii topogr.
TUMORI MALIGNE
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TUMORI MALIGNESECUNDARE
II.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”
A B
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METASTAZE OSOASE:A)OSTEOLITICE;B) OSTEOPLASTICE
Cancer mamar Cancer prostatic
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METASTAZE OSTEOLITICE BASIN
CANCER MAMAR T-4
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METASTAZE OSOASE OSTEOPLASTICE:pete de ceara (Reboul)
Rad./imag-Iasi-2003
NECROZE ASEPTICE
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NECROZE ASEPTICE MECANISM:-modificari ale vascularizatiei locale
-post-traumatice-embolii gazoase (boala de cheson). 1)OSTEONECROZA CAPULUI FEMURAL=boala LEGG-CALVE-PERTHES):-distructie progresiva a capului fem.; spatiuarticular pastrat, cavitate cotiloida normala--evolutie spre anchiloza, subluxatie, coxartroza2)OSTEONECROZA TIBIALA ANTERIOARA=boala OSGOODSCHLATTER-LANELONG): -cioc, ”nas de tapir”, decolare siosteosinteza (realipire) sau detasare de fragment(“soricel..”). 3)VERTEBRALA=cifoscolioza juvenila(b. SCHEUERMANN)
-vertebre tasate, cuneiforme, scolioza, cifoza, herniiintraspongioase (noduli Schmorl), (platouri vertebraleancosate)
-evolutie--spondilartroza precoce.
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NECROZA ASEPTICA A CAPULUI FEMURAL
NECROZA ASEPTICA A CAPULUI FEMURAL:DEBUT
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Forma adultului Rad./imag-Iasi-2003
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NECROZA
ASEPTICA A
CAPULUI
FEMURAL:
TOMOGRAFIE
PLANA
COMPUTER
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COMPUTER-
TOMOGRAFIE
NECROZA ASEPTICA
CAP FEMURAL
Rad./imag-Iasi-2003
NECROZA ASEPTICA A
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NECROZA ASEPTICA ACAPULUI
FEMURAL; SECHELE:
SUBLUXATIE
Rad./imag-Iasi-2003
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NECROZA ASP\EPTICA A CRESTEI TIBIALE ANTERIOARE
(OSGOOD-SCHLATTER-LANELONG)
NECROZA
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NECROZA
ASEPTICA A
SCAFOIDULUI
Rad./imag-Iasi-2003
-osteoliza in fragmente,condensare reparatorie, curesudarea unor fragmente;-deformarea scafoidului
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NECROZA ASEPTICA
A CAPULUICELUI DE-AL 2-LEA
METATARSIAN
(KOHLER II)
Rad./imag-Iasi-2003
-osteoliza fragmentata aepifizei distale metatarsian2;-evazare a metafizei sidiafizei,ingrosarea
compactei prin reparatieostocondensantaendoosoasa si periostala
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IRM(T-2)scapulo-humerala
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Geode pe capul humeral;epansament inarticulatie (puroi)
puroi
geode
Aspectul normal
ARTRITA SEPTICA SCAPULO-HUMERALA
Artrite cronice nesupurate
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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.perivertebraleanrtero-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:MODIFICARI SACROILIACE
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SPONDILITAANKILOZANTA: SINDESMOFITE
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SPONDILITA ANKILOZANTA:SINDESMOFITE CERVICALE
SPONDILITA ANKILOZANTA;EXTENZIE-artrita coxo-femurala;
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-anchiloza artrita/artroza sec.
sindesmofite
Artrite cronice nesupurate
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t te c o ce esupu ate2.POLIARTRITA REUMATOIDA.CLINIC: -boala artritica cu teste inflamatorii pozitive-etiologie incerta=> componenta autoimuna probabila.DEBUT:-articulatii mici: interfalangiene, carpiene; -osteoporoza; largirea spatiului articular; chisturi, microgeodesubchondrale 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 dominantmetafizo-epifizara si
carpiana;-micro geodeepifizare falangiene;-micisubluxatii interfalangiene;-ingustare a spatiilorarticulare interfalangiene
Rad./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:mina in “ feuille au vent”
ARTROZA DEFORMANTA
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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; sclerozasubchondrala; modificari epifizare: ”slefuire”, dezrotunjire”;
-osteofitoza marginala: productii osoase spiculare peinsertii 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 DEFORMANTA
-scleroza platourilor;-pensare spatiudiscal;-osteofitoza
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IRM:MIELOPATIE CERVICARTROZICA
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IRM:MIELOPATIE CERVICARTROZICA
s. sagitale Sectiuneaxiala
Lacuna medulara=siringomielie
IRM Di
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IRM :Discartroza
Gadolinium IVTesutul inflamator
capteaza contrastul paramagnetic
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ARTROZA DE GENUNCHI (“GONARTROZA”)
IRM T2
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IRM,T2:
Fisura menisc + chist
Echo de spin
chist
-fragmentare meniscala;-hipersemnal de tip lichidian incapsulat=chist
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osteofiteRadiografieit di t
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ARTROZA DE GENUNCHI:”VID ARTICULAR”
marita direct
Rad./imag-Iasi-2003
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ARTROZA AVANSATA
DE
GENUNCHI
(GONARTROZA) -productii osoase
peri/intraarticulare de tiposteofitic;-deformari aleepifizelor(rotunjire,sclerozasubchondrala
Rad./imag-Iasi-2003
Rad./imag-Iasi-2003
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COXARTROZA IN STADIU AVANSAT (ANKILOZA)
TUBERCULOZAOSTEO ARTICULARA
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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 articulareFORME 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
-pensare spatiu discal;-ostoporoza;- geoda “in
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MORB POTT:LEZIUNI MINIMALE LOMBARE
oglinda” pe platourileadiacente;-tendinta lasudare vertebrala(“bloc”)
LAT AP
PA LAT -sudare in “bloc vertebral”
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MORB POTT DORSAL: osteoliza, tasare, ”fus” paravertebral
Abces rece
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BLOC VERTEBRAL SECUNDAR MORBULUI POTT
CT: MORB POTT
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Abcesul“rece”
OSTEOLIZAVERTEBRALA &DISTRUCTIE
DISCALA
osteoliza
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COXITA TBC
(“COXALGIA”) DEBUT / STARE
-osteoporoza marcata;-pensar/disparitia spatiului
articular;-deformare litica a capuluifemural;-largirea cavitatii cotilului;-osteoliza a marelui trohanter.
Rad./imag-Iasi-2003
-fractura funduluit b l t i
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COXITA TBC: EVOLUTIE; COMPLICATIIArtroza/anchiloza Extenzie :focare ischio-pubiene
acetabular ;-protruzie acapului femural in pelvis
geoda
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TUBERCULOZA GENUNCHIULUI :“TUMORA ALBA DE GENUNCHI”
cazeumcalcificat
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TUBERCULOZA GENUNCHIULUI:“TUMORA ALBA DE GENUNCHI” ;LUXATIE SECUNDARA
OSTEOLIZA EPIFIZARA OLECRAN;osteoporoza
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TUBERCULOZA COTULUI:PERIOADA DE STARE
TUBERCULOZA DE
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PUMN
(RADIO-CARPIANA);PERIOADA DE
STARE
-osteoliza extinsa la multiple oasecarpiene;-distructie osteolitica si aepifizelor distale radius si cubitus;-tumefactie evidenta a partilor moi
periarticulare;-osteoporoza marcataregionala.
Rad./imag-Iasi-2003
ALTE AFECTIUNI OSTEO-
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ALTE AFECTIUNI OSTEOARTICULARE
• HERNIA DISCALA;• DISCARTROZA
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HERNIE DISCALA L-5/S-1:RADIO.DIGITALA & CT.
CT-VERTEBRO
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DISCALA:
HERNIE
IRM : Hernie discală
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Protruzie discală focală
Sectiune axiala Sectiune sagitala
Displazii osoase
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Sunt tulburari de crestere, osificare si dezvoltare ascheletului ce produc modificarea formei, structurii sauopacitatii 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 sedezvolta in alt sens decit lungimea osului; boala tip:exostozeosteogenice (Boala Ombredanne)
Rad./imag-Iasi-2003
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Displazii osoase
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Osteogeneza imperfecta letalis-Boala VROLICK-
Oasele craniuluisubtiri,compacta redusa
Scoliostoze prin deficit de grosime/rezistenta a compactelor;
fracturi “in lemn verde”;calusuri vicioase in utero
Displazii osoase
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Osteogeneza imperfecta forma tardiv ă
-Boala LOBSTEIN-
Displazii osoase
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Acondroplazia- 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 întrident)
--craniu- oase frontale proeminente, amprente digitale--vertebre cuneiforme
Displazii osoase
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Acondroplazia
Displazii osoase
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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 inalt ime uşor crescut a--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 + anomaliiepifizare + eliminare urinara de keratosulfat
Displazii osoase
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Displazia spondilo-epifizara precoce
-Boala MORQUIO-
PLATISPONDILIE
Epifizeturtite,nemodelate
Displazii osoase
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Boala oaselor de marmura (osteopetroza, b. Albers-Schonberg)-familiala, ereditara-îngroşarea trabeculelor spongioasei, compactei cu sporire difuza aopacităţii scheletului ;-canalul medular al oaselor lungi micsorat /
disparut;-tesutul spongios cu densitate de compacta-striatii caracteristice în zonele de crestere:-benzi opace alterni nd cu benzi mai puţin opace ,în metafiza oaselorlungi- aspect de brad;-oase iliace- benzi arciforme;-vertebre-2 zonedense spre platouri (vertebre ” în sandwich ”); -craniu voluminos,oasele boltii ingrosate;virsta osoasa normala, absenta calcificarilor inalte tesuturi;-fracturi frecvente
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Boala Paget
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gDistrofie a oaselor lungi si craniu cu evolutie cronic ă:-oase lungi- debut diafizar, cu decalcifierea (os cu aspect sters);-compacta se ingroasa prin apozitie periostala,remanierespongioasa ( “se spongiozeaza”)= structura fibrilara cu trabeculegroase. Oasele lungi se alungesc, se ingroasa, se curbeaza, aparfracturi.-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
Boala Paget
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