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Curs14-Radiodg Sist Osteoarticular!

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diagnosticarea imagistica a intregului sistem articular precum si analiza structurii osoase componente
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R A D I O D I A G N OSTI C U L SIS TE M U LUI O S TEO AR TI CUL AR 2 0 1 2 0 1 3 3
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RADIODIAGNOSTICULSISTEMULUI

OSTEOARTICULAR

20120133

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I. Anatomia radiologică a osului normal

Scheletul osos – alcatuit din:

 - oase lungi (diafiza, metafiza, epifiza)

 - oase late si

 - oase scurte

Macroscopic →osul normal alcatuit din:

 - o portiune centrala (os spongios cu spatii medulare)

  - o portiune  periferica, densa, dura (os compact)inconjurata de periost

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I. Anatomia radiologică a osului normal

Tesutul osos = forma diferentiata a tesutului conj.(din careproine prin metaplazie osoasa)

!p histologic osul adult are " componente principale:

  - su#stanta osoasa dura (lamele$tra#ecule) = structura derezisten%ă a osului – opace la radiatii &  - spatii osoase – intre lamele - (ocupate de tesuturi conj. moi si

ase nutritie)=spatii medulare, transparente la radiatii &

' u#stanta osoasa dura = matricea proteica (suportul in carese depun sarurile minerale, mai ales cele fosfo-calcice)

' omponenta minerală fosfo-calcică, radio-opacă – realizeazacontrastul natural dintre os si celelalte structuri moi peradiografie

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I. Anatomia radiologică a osului normal

!iafiza unui os lung  (forma cilindrica) = alcatuita din tesut ososcompact ce inconjoara si delimiteaza canalul medular 

*e rtg. – diafiza = " #enzi opace paralele care delimiteaza canalulmedular (mai transparent)

Compacta  osoasa = sisteme tu#ulare +aers (lamele osoasedispuse in sisteme cilindrice concentrice, paralele cu aul osului)

patiile osoase = lumenul canalelor +aers (paralele intre ele) si alcanalelor ce le unesc (canale anastomotice, perpendiculare peprimele – canale olmann)

Corticala  osoasa = portiunea compactei care se su#tiaza siformeaza conturul articular al epifizei si metafizei osului

/a ni. metafizei (intre diafiza si epifiza) si epifizei osului lung:lamelele compactei formeaza tra#ecule ce se intretaie (in retea) si

sunt orientate in sensul liniilor de for%a = spongioasa (inlocuiestecanalul medular)0 1ra#eculele spongioasei sunt orientate f-ctie de modul de solicitare

al articulatiei respectie (presiune $tractiune)

0 *eriostul = mem#rana conj. (transparenta la rad.&) – ineleste osul

si se continua cu capsula articulara (la ni. etremitatilor)

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 Anatomie osoasa normala

Sistemul de canale Havers

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 Anatomie osoasa normala

1 OSTEON (HAVERSIAN SYSTEM)2 ENTRA! ANA!" IR#M$ERENTIA! !AME!!A% !AME!!A& SHAR'EYS $IERS* 'ERIOSTE#M+ OSTEOYTES IN !A#NA

Sistem Havers (osteonul)

Aspect la microscopie electronica

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I. Anatomia radiologică a osului normal

Osul lat , alcatuit din corticale paralele (ta#le osoase)

intre care este o spongioasa (diploe) : e. 2asele #oltiicraniene, unite prin suturi (=sinartroze)

2asele spongioase sau scurte – masa de os spongios

inelit intr-un manson periostal sau intr-o corticala f.su#tire ((erte#rele, oasele carpiene)

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 Anatomie osoasa

$e-ur. Spong/ #one is less dense t3an compact #one.13e orientation of t3e tra#eculae is affected #4 t3emec3anical stress to 53ic3 t3e #one is eposed

Trabecule os spongios

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Structura os spongios: orientareatrabeculelor osoase

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I. Anatomia radiologică a osului normal

Articula0iile (siste- -ecanic). – asigură legătura 6ntre oase

 - alcatuite din " $mai multe etremitati osoase, mentinute incontact prin capsula, ligamente si tendoane

  - la ni. articulatiilor – corticala osoasa este inelita cu unstrat de cartilaj 

Tipuri. !iartroze: articula%ii sinoiale ( scapulo-3umerale, sold, genunc3i)7

caitatea articulara este aproape irtuala si este tapetata cumem#rana sinoiala care secreta lic3id articular 

 Amfiartroze: legătură prin structuri fi#ro-cartilaginoase(intertarsian, corpurile si discul erte#ral)

inartrozele: legături 6ntre oase prin structuri fi#roase (suturile

craniene, artic. acro-iliace)

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I. Anatomia radiologică a osului normal

/a ni. !iartrozelor :

  - spatiul articular anatomic   nu este izi#il radiologic, etremitatileosoase se sprijina intre ele prin cartilaj diartrodial (radiotransparent)

 - spatiul articular radiologic  (interliniul articular) = distanta intre corticalaetremitatilor articulare → radiotransparenta cu grosime de 8-9 mm (f-ctie de grosimea cartilajului diartrodial)

0 /a copii: spatiul articular este cu atat mai larg cu cat nucleii ososiepifizari sunt mai putin dezoltati

0 In caz de epansament lichidian : largirea si oalarea spatiuluiarticular, etremitatile osoase sunt indepartate intrel ele la ni. artic.

0 In cazul distrugerii cartilajului diartrodial si uzurii si distrugeriicorticalei fe%elor articulare osoase: spatiul articular ingustat (pana ladisparitie), imprecis delimitat, fe%ele articulare osoase cu conturneregulat, iar tra#eculele spongioasei din cele " etremitati articularein in contact si c3iar pare ca se interpatrund

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Diartroza: articulatie genunchi

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Rtg. Articulatie genunchi copil

Epiphyseal plates arepresent in the long

bones until late puberty when theyfnally close. Theplates are suppliedwith blood by theepiphyseal arteries.Epiphyseal lines canbe seen on the x-rayso children.

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 Articulatie glezna:nucleii epifizari

Salter-Harris IV Fracture . hite arrow points tometaphyseal racture and yellow

arrow to a racture o the distal tibial epiphysis in thisSalter-Harris !" racture o the an#le $gle%na&

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 Amfiartroze:articulatiileintervertebrale

(legătură prin structurifi#ro-cartilaginoase)

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In cazul distrugerii cartilajului diartrodial si uzurii si distrugerii corticalei fe%elorarticulare osoase: spatiul articular ingustat (pana la disparitie), imprecis

delimitat, fe%ele articulare osoase cu contur neregulat, iar tra#eculelespongioasei din cele " etremitati articulare in in contact si c3iar pare ca seinterpatrund

TBC genunchi

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Sinartroze:oasele boltii craniene

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I. Anatomia radiologică a oaselor:patologie

riterii de descriere: umărul segmentelor osoase afectate

;onostic$monotop *oliostic$politop

;odificări de formă <i dimensiune: alungire, scurtare,deformare, 6ncur#are (scoliostoză), suflare(oedostoză), su#%iere$6ngro<are

;odificări de spa%iu articular: lărgire, 6ngustare,dispari%ie

/ocalizarea procesului patologic: diafiză, metafiză,epifize orma procesului patologic: rotund, oalar, etc. onturul procesului patologic: #ine delimitat, imprecis

delimitat, <ters, infiltrati

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II. /eziunile elementare osoase !e3iuni ele-entare osoase 4istructi5e

Osteoporoza Osteoliza Osteonecroza  Atrofia prin compresie

!e3iuni ele-entare osoase reconstructi5e Osteoscleroza Periostoza Osificările heterotope Distrofiile osoase 

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16 Osteoporo3a!iminuarea cantită%ii de săruri fosfo-calcice(demineralizare)cu păstrarea matricei conjunctie → creste transparenta

osoasa >tiopatogeneza

+iperemia intraosoasă – cu modificări de p+ tisular → acidozăinterstitiala cu pierdere de saruri fosfo- calcice ( in inflamatii ac.sau cr. ale oaselor, tumori, dupa fracturi imo#ilizate in gips)

 Aport calcic alimentar insuficient ( tul# de a#sor#%ie intestinală),caren%a de itamina , !

In ra3itism, osteomalacie: lipsa de mineralizare a matriceiproteice a osului (matricea ramane su# forma de %esut osteoidradiotransparent)

caderea progresia a reconstruc%iei osoase: #ătr?ni(osteoporoza senila – fenomen fiziologic difuz), cu fracturi frec.de col femural

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Osteoporo3a

>tiopatogeneza 2steoporozele endocrine si in unele distrofii (alterarea trameiproteice a osului): in postmenopauza, osteogenezaimperfecta(insuficienta tesutului mezenc3imal)

+iperfunc%ie paratiroidiană (eli#erare calciu din os) - #oala

@ecling3ausen actorul mecanic: suprimarea actiitatii musculare si a presiunii de

sustinere →creste circulatia locala cu resor#tie osoasa (osteoporozaalgicaB prin imo#ilizare)Costeoporoza localizata dupa traumatismesi fracturi indelung imo#ilizate

>agerarea tractiunii → fracturi de o#osealaB >agerarea presiunii → atrofii osoase (prin comprimarea matricei

proteice, care se deformeaza fara ca elementele conjunctie aleosului sa fie intrerupte) → anerism Ao

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Osteoporo3a

2steoporoza se apreciaza radiologic dupa resor#tia aDEF din compleul mineral

/a inceput: se apreciaza prin comparatie cu parteasanatoasa (pe rtg)sau prin osteodensitometrie

@tg.:  - spongioasa cu tra#ecule la inceput su#tiate, apoi mai

rare, cu oc3iuri mai largi intre tra#ecule→porozareaspongioasei

  - in timp→spongiozarea compactei ( cu aspect despongioasa dat. su#tierii peretilor sistemului +aers silargirii lumenului lor7 canalul medular este largit dat.su#tierii compactei)

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Osteoporoza

'ap emural normal si osteoporotic

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1. Osteoporoza (orme clinico-radiologice

Osteoporoza intalnita in procesele infamatoriiosoase )steomielita acut*  Tuberculo%a osoas*

Osteoporoza din osteoartropatiile dismetabolice +ahitism-vit , Scorbut-vit ' )steomalacie

Osteoporoza în osteoartropatii discrinice oala +ec#linghausen Sindromul suprareno-metabolic --'ushing

Osteoporoza în procese tumorale )steosarcomul osteolitic central )steosarcomul Ewing lasmocitomul

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2. Osteolizaproces de distruc%ie osoasă interes?nd toate componentele osoase

(matricea conjunctiă si compleul fosfocalcic) → “pierdere desubstanta osoasa”→ radiotransparenta

Fiziologie )steoli%a / roces de osteocla%ie 0 osteoclastul $celula

speciali%at*1 cu origine in me%enchim& distruge complet

osul prin proces de agocito%a (i%iologic* $ex. remodelarea calusului& atologic*: carie1 u%ur*1 chist1 cavern*1 gom*1 osteoli%*

central* Forme clinico-radiologice

1. Osteoliza din artropatiile infamatorii )steomielita acut*  Tuberculo%a osteoarticular* Siflisul osos

2. Osteoliza în artropatii discrinice oala +ec#linghausen

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2. Osteolizaproces distructi interes6nd toate componentele osoase

Forme clinico-radiologice3. Osteoliza în distroi osoase

'histul osos esen2ial  Tumora cu celule gigante )steomul osteoid )steodistrofa fbroas* locali%at* 3a4e-5ichtenstein

!. Osteoliza în tumorile osoase  Tumori osoase benigne: fbrom1 condrom1 condromato%*

osoas*  Tumori osoase maligne: osteosarcomul1 sarcomul

condroblastic1 sarcomul osos Ewing1 fbrosarcomul1metasta%ele osteolitice1 plasmocitomul

". Osteoliza în bolile de depozit 5ipoido%e oala Hand-Schuller-'hristian 6ranulomul eo%inoflic

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Granulom eozinofil

0 Copii si tineri pana la 2 ani0 este o reticulo!a" a#ectea!a sistemul reticulo$

endotelial0 mai rar la oase lungi" in dia#i!a

0 evolutie #avorabila (dupa curetare sauradioterapie →reosi#icare)

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%on& e'tins& de osteoli!& a aripii iliace stngi (osteosarcom

osteolitic)

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steosarcom osteolitic

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Spre deosebirede:Osteosarcom(cu

predominentaproceselorosteoproductive)

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3. Osteonecroza

,efni2ie:proces distructiv osos ap*rut printulb. de vasc. dat. obstruc2iei unui vassanguin osos de cau%* septic*-aseptic*

dispar osteocitele, tesutul conj. din spatiile osoase este alterat, darsubstantele minerale si structura dura raman intacte→opacitatecalcara pastrata (sec3estru osos radioopac )

(orme clinico-radiologice )steonecro%e septice: osteomielita acut*

)steonecro%e aseptice $epif%ele mai intenssolicitate 0 cap emural1 apof%e1 oase mici&

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Osteonecroza (cap femural)

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4. Atrofia prin compresie:proces distructiv osos produs princompresie asupra vaselor care irigă osul

7nevrism aortic 'hist osos 8eurinom de acustic 6anglioneurinom

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Chist Osos

2edostoza (sufla osul): presiune interioaraprodusa de leziunea #enigna in crestere(c3istul osos) o eercita pe fa%a interna acompactei

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2steoscleroza = producere ecesia de tesutosos:depunere 6n eces de săruri fosfo-calcice, 6ngro<area traeelorosoase <i compactei osoase, cu <tergerea spongioasei <i canaluluimedular→ creste opacitatea osului ,up* sediu: Spongioscleroza# produc2ie de os nou la nivelul

spongioasei $ex. 'orp vert.&: trabecule osoase ingrosate1spatii medulare osoase micsorate9umplute cu os nou onoastic* monotop* oliostic* politop*

$ndostoza# produc2ie de os nou la nivelul compactei1

spre canalul medular $pana la obstruarea acestuia& ;ngro<are de compact* )bstruare de canal medular

%eriostoza# ingrosarea osului prin apozitii osoase in jurul compacteidiafizare

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Osteoscleroza

oate f:

,iseminata: insule$osteopoechilie1 metaosteosclerotice 0 ex. cancerul de prostata& 5ocali%ata: osteite cronice1 osteom1 tu. al& 6enerali%ata: boala oaselor de marmura

= osifcarile heterotope: in muschi1 ligamentearticulare1 in tesutul con>. din cicatrici

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Osteoscleroza

(orme clinico-radiologice Osteoscleroza în procese infamatorii osoase:

)steomielita Tuberculo%a osoas* Siflisul osos

)steosclero%a ?n distroile osoase )steomul osteoid )steodistrofa deormant* aget eloreosto%a 5eri )steopoichilia 7lbers-Schonberg

)steopoichilia "oorhoeve )steopetro%a 7lbers-Schonberg oala 'amuratti-Engelmann Hiperosto%a rontal* intern* $sdr. orell-orgagni-Stewart&

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Osteoscleroza

(orme clinico-radiologice Osteoscleroza în bolile sanguine Osteoscleroza în into&ica'ii cu

metale(metaloide )steosclero%a bismutic* )steosclero%a ?n saturnism $b& )steosclero%a ?n intoxica2ii cronice cu osor

Osteoscleroza în tumori osoase )steosarcomul osteocondensat etasta%e osoase osteosclerotice

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Osteomielita cronica

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Osteita condensanta os iliac

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Periostoza=formarea de os la nivelul periostului

eriostul normal $membran* fbro-elastic*& nuare expresie radiologic* @

"asculari%a2ia periostului este ?n rela2ii strAnse

cu vasculari%a2ia osului <i a musculaturiiadiacente

eriosto%a9apo%i2ia periostal* se eviden2ia%*radiologic la B-C s*pt*mAni de la debutultulbur*rilor de circula2ie periostal*@ 5ocal* +egional* 6eneral*

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Periostoza Tipuri de reac2ie periostal* :

)eac'ie periostal* continu*)eac'ie periostal* continu* 'u cortical* distrus*Expandat*1 ?n carapace simpl* ;n carapace ondulat* ;n creast* de scoic*1 cu trabecula2ii1 Dbule

de s*pun 'u cortical* intact*paraleli Solid*1 neted*1 ondulat*Spiculi soli%i5amel* unic*5amele multipleSpiculi ?n perieSpiculi divergen2i1 ?n ra%e de soare

)eac'ie periostal* întrerupt)eac'ie periostal* întreruptaa# triung+i# triung+i,odman,odman cu lamel* unic*9cu lamel* multipl*1

spiculi

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Periostoza

(orme clinico-radiologice %eriostoza în infama'ii osoase

)steomielita staflococic* Siflisul osos Tuberculo%a osteo-articular* 7ctinomico%a rocese inFamatorii periosoase $celulite1 mio%ite&

%eriostoza în leziuni traumatice Hematoamele subperiostale 0 periosto%a

%eriostoza în aec'iuni reumatismale(colagenoze

'E Spondilita anchilo%ant* artro%e

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Periostoza

(orme clinico-radiologice %eriostoza în aec'iuni dismetabolice: rahitism1

scorbut $lipsa vit '&1 hiperuricemie %eriostoza în discrinii: acromegalia1 boala

+ec#linghausen %eriostoza în tulbur*ri circulatorii: varicele1

arteritele diabetice1 arteritele senile %eriostoza în tumorile osoase: osteosarcomul

osteocondensat9litic1 sarcomul Ewing1 sarcoameparostale1 metasta%e osoase

%eriostoza în alte procese tumorale /i în boli desistem# meningioame1 boala Hodg#in1 sarcoido%a1leucemiile1 cancerul mamar

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 Tulburări distrofice osoase

= tulburări care modifică profund macrostructuracompactei şi spongioasei osoase

7u loc procese distructive  si reparatorii  osoase$osteoproductive& anarhice

*

structura anatomica a osului este modi#icata

 $ST+G'TG+7 ,E +E!STE8IJ 75TE+7TJ&

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 Tulburări distrofice osoase

'lasifcare topografc*

onoostice9monotope: 'histul osos solitar )steomul osteoid

oliostice: osteodistrofa fbroas* 3a4e-5ichtenstein 6enerali%ate: osteita deormant* aget

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Boala Paget

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lb ăidi fi

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 Tulburări distrofice osoase=tul#. de crestere

si osificare a sc3eletului

 Tubur*ri de orm* Scoliosto%a / incurbarea axului osos

;n osteoartropatii dismetabolice $rahitism1 osteomalacie& ;n distrofi osoase

oala 3a4e-5ichtenstein1 boala +ec#linghausen ;n tumori osoase ;n displa%ii encondrale: boala asel-Hagen1 boala

andelung ;n displa%ii con>unctive: osteopsatiro%a 5obstein

)edosto%a 0 enomenul de suFare si ingrosareconsecutiva osoas* $chist osos1 tu. cumieloplaxe&

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Tul7ur8ri 4istro9ice osoase Hiperosto3a

 - cresterea eagerata a osului in grosime prin apozitii periostale

(osteomielita, #oala *aget)  Hiposto3a

  - oasele raman in urma cu dezoltarea (e. osteopsatiroza, leziuni

inflamatorii care altereaza cartilajul de crestere)

Hiperpla3ia

  - dez. mai pronuntata a unuia sau mai multor oase, uneori a intregului

sc3elet (gigantismul 3ipofizar)

Hipopla3ia

  - proces iners, apare in 3ipofunctia 3ipofizara, cu secretie deficitara a

3ormonului de crestere (nanism) Apla3ia - lipsa de dezoltare osoasa

  Agene3ia. lipsa constitutionala a osului

 

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Osteopoichilie

(poichilos = pătat)- rar intalnita, opacitatirotunde-ovalare, nodulare, ”catun bold de ac“, la oaselemainilor si picioarelor

!istrofieosteocon4ensanta:

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0istroi cu ruperea ec+ilibrului dintrecre/terea encondral* /i cea periostal*

  periostale  (lipsa de opacitate a scheletului , cu insuficienta dez. acorticalei  osoase care este su#tire, cu lipsa spongioasei):osteogeneza imperfectă rolic, osteopsatiroza /o#stein

  encon4rale  (condrodisplazii – tul#urari in eolutia si dezoltarea

mac3etei cartilaginoase a  epifizelor sau cartilagiilor de crestere →aspect de pitic disproportionat, cu deformarea trunc3iului sietremitatilor, craniul cu #aza larga, oasele lungi au diafiza scurta, cu

cifoscolioza = corpi erte#rali turti%i, mici, #iconcai, cuneiformi&:sindrom orKuio1 sindrom Hurler $gargoilism&1 acondropla%iaarrot

,ispla%ii direc2ionale: boala exosto%ant*1condromato%a osoas* $ insule cartilaginoase la Ldin schelet / boala)llier sau generali%ata la totscheletul&

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Osteogeneza imperfecta (boala sclerelor albastre)+ congenitala+ apare la

nastere+ mortala"0 este insu#icienta a tesutului me!enchimal →tesutul con,- subperiostic nu se

de!volta coresp- (corticala este #- subtire+ spongioasa lipseste sau este #-

la'&+ iar canalul medular este larg)-0  oasele lungi" subtiri+ transparente (boala oaselor de sticla)+ cu #racturi

multiple si repetate+ cu calusuri e'uberante+ oasele indoite si scurte+

membrele #iind de#ormate0  osi#icarea craniului $ oasele late " insu#icienta si inegala (lipsa

spongiosei→consistenta moale de “mar putred”) 

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Osteogeneza imperfecta

Aspect radiologic al craniului" in mo!aic+ patat+ dat- .nsulelor

de osi#icare opace in masa membranoasa a calotei craniene+

care este transparenta

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Osteoartropatii traumatice

(racturile osoase 5uxa2ii

Entorse

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Fracturile osoase:intreruperea continuitatii unuios, determinata de actiunea directa sau indirecta a agentilor

traumatici 

Examenul radiologic – importanţă deosebită Confrmă supoziţia clinică de ractură şi mecanismul

 probabil de producere Precizează sediul racturii Precizează numărul ragmentelor  Furnizează date priind structura osului racturat !os

sănătos"patologic#

 $rată dacă reducerea a ost corectă cu consolidarenormală"icioasă

Permite urmărirea eoluţiei racturii sub tratament %calusul

Permite ealuarea prognosticului racturii

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Fracturile osoase – banda de radiotransparenta(indepartarea fragmentelor osoase)sau de opacitate (tasare,incalecarea fragm. osoase)

,lasicare# ,up* intensitatea <i durata traumatismului

Ex. : (racturi de or2* (racturi de oboseal* $de mar<&

,up* terenul osos: ?n os s*n*tos9patologic $tu.1

metasta%e1 osteopatii endocrine1 senile1 etc&

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Clasificarefracturi osoase-continuare: ,up* mecansimul de producere

rin Fexiune rin compresiune rin trac2iune rin torsiune 

,up* aspectul radiografc:

  - complete1- incomplete $?n Dlemn verde: la copil1 se produce pe marginea convexa

a osului → sec. Fexiei exagerata a unui os lung→  ractura are loc lanivelul convexitatii maxime1 cu pastrarea continuitatii corticaleicontrolaterale&

  - subperiostale $la varste tinere1 ractura completa1 ara deplasare sau

cu deplasare minima1 ragm. osoase find mentinute prin elasticitateaperiostului&→ dg. @adiol.de fractura poate fi dificil (traiectul fracturii insesiza#il),eident uneori numai dupa aparitia calusului

 

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Fractura<in lemn verde>

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http"//atlas-mudr-org/img$0reenstic1$#racture$

o#$radius$and$ulna$subperiosteal

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ractura subperiostala os lung

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Fracturile osoase

'lasifcare ,up* sediul racturii: diaf%are1 diaf%o-epif%are1 epif%are ,up* num*rul traiectelor de ractur*

Gnice 9 multiple 'ominutive

,up* direc2ia liniei de ractur* Transversale )blice Spiroide 5ongitudinale $extrem de rare&

,up* dislocarea ragmentelor racturate: deplas*rilongitudinale1 deplas*ri laterale

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Fracturile osoase

Evolu2ia racturilor "indecare 0 calus provi%oriu 0 calus defnitiv 'omplicare

'alusuri anormale 0 apar dat. po%itiei vicioase a ragm.

osoase $sudare ?n baionet*1 unghi1 rota2ie& 'alusuri cu evolu2ie patologic*

'alusuri exuberante seudoartro%*

)steoporo%a dureroas* $aspect patat&

'alcifc*ri anormale $paracondiliana interna a emurului0 dedublea%a conturul condilului intern emural& io%ita osifcant* post-traumatic* $osteoame in

muschiul brahial anterior&

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ractur& 3outeau$

Colles

ractura e'tremitatii distale a radiusului (cu deplasarea dorsala a #ragmentului

distal4 din pro#il cu aspect de “mana in dos de #urculita”)

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ractur& ba!in

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  Fractura coloanacervicala

ractura bimaleolara cu diata!a tibio$

 peroniera 5upu6tren

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Fracturile osoase

(isurile osoase: linii de ractur* incomplete 5ocali%are oarte dierit*

,iagnostic dieren2ial al racturilor osoase: 'anale vasculare osoase 'artilagii de crestere )ase supranumerare !magini de suma2ie $necesare B incid.&

8uclei de osifcare nesuda2i )sifcari in tendoane

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Fracturile osoase

Evolu2ia racturilor "indecare 0 calus provi%oriu 0 calus defnitiv 'omplicare

'alusuri anormale 0 apar dat. po%itiei vicioase a ragm.

osoase $sudare ?n baionet*1 unghi1 rota2ie& 'alusuri cu evolu2ie patologic*: 'alusuri exuberante →de%voltare exagerata a calusului1 de

obicei sec. tratamentului incorect al unei racturi 9 racturiignorate1 negli>ata1 neidentifcate

seudoartro%*

)steoporo%a dureroas* $aspect patat& 'alcifc*ri anormale $paracondiliana interna a emurului 0dedublea%a conturul condilului intern emural&

io%ita osifcant* post-traumatic* $osteoame in muschiulbrahial anterior&

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CA78S 9:8B9;A<T

PSEUDARTROZA

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PSEUDARTROZA

3seudartro!a (articulatie#alsa)" 9ste re!ultatul

neconsolid&rii

e'tremitatilor osoase la

nivelul unei #racturi

Gragmentele osoase apar

hipertro#iate si cu opacitate

crescuta datorita proceselor

de osteocondensare+ in timp

ce intre #ragmentele osoaseramane un spatiu

radiotransparent

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Luxaţii

,efni2ie: ;ndep*rtarea suprae2elor articulare1 cu

modifcarea raporturilor anatomice 'lasifcare: 'ongenitale: luxa2ia congenital* de <old atologice: 'E1 artrite nespecifce9specifce Traumatice:

Scapulo-humeral* 'ot 'oxo-emural*

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Luxatie humerala

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Entorse

,efni2ie:

5e%iuni traumatice cu le%area ?n dierite grade aaparatului ligamentar1 dar cu men2inerea suprae2elorarticulare ?n contact

(*r* expresie radiografc*M in ca%ul smulgerii deragment osos din %ona de inser2ie ligamentar* 0vi%uali%are radiografc*.

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 Traumatologia maxilo-facială

7. (racturile maxilarului superior. (racturile maxilarului inerior'. (racturile arcadei temporo-%igomatice

,. (racturile oaselor na%aleE. (racturile 7.T..

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 A. Fracturile maxilarului superior

Examenul radiologic este indispensabil Eviden2ia%* ractura <i o locali%ea%* Eviden2ia%* traiectul racturii: transversal1 oblic1 spiroid1

longitudinal <i mixt reci%ea%* num*rul <i m*rimea ragmentelor1 dac* sunt sau

nu disclocate reci%ea%* structura osului din >urul racturii reci%ea%* dac* sunt sau nu asociate racturi ale din2ilor sau

ale regiunilor ?nvecinate la distan2* ermite stabilirea atitudinii terapeutice privind alegerea

metodelor de reducere <i imobili%are de urgen2* defnitiv* ,escoper* corpii str*ini radioopaci proiecta2i ?n 2esuturile moi 7precia%* corectitudinea tratamentului ortopedic <i evolu2ia

normal*9anormal* a procesului de consolidare osoas*.

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 A. Fracturile maxilarului superior

Evaluarea traiectelor de ractur* maxilo-aciale 5iniile lui 'ampbell <i c6regor

'urba orbitar* superioar* 'urba orbitar* inerioar*

'urba palato-na%al* 'urba oclu%al*

5iniile lui 5e ,inh1 6inestet <i +obert uchet 5inia ronto-%igomatic* superioar* 5inia orbitar* inero-lateral* 5inia maxilo-%ygomatic* inerioar*

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!iniile lui a-p7ell :i Mc;regor !iniile lui a-p7ell :i Mc;regor 8.8. ur#a or#itară superioarăur#a or#itară superioară

".". ur#a or#itară inferioarăur#a or#itară inferioară

D.D. ur#a palato-nazalăur#a palato-nazală

9.9. ur#a ocluzalăur#a ocluzală

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!iniile lui !e <inh=!iniile lui !e <inh=;inestet :i Ro7ert;inestet :i Ro7ert uchetuchet

16 !inia 9ronto,3igo-atic8

superioar8

26 !inia or7itar8 in9ero,lateral8

"6 !inia -a>ilo,3/go-atic8in9erioar8

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 A. Fracturile maxilarului superior

'lasifcare Fracturi totale

Fracturi orizontale: inerioare $5e (ort !&1 mi>locii $5e (ort !!&1 superioare $5e (ort !!!&

Fracturi erticale /i oblice: medio-sagitale1 laterale

Fracturi combinate: ractura +ichet <i alther Fracturi cominutie

Fracturi par'iale: creast* alveolar*1 bolt* palatin*1 pere2i sinusali1

apof%a %igomatic*

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ractura ori!ontal& in#erioar&" #ractura 7e ort .

sau 0uerin

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ractura ori!ontal& mi,locie" #ractura 7e ort ..

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ractura ori!ontal& superioar&" #ractura 7e ort ...

l l l f

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B. Fracturile maxilarului inferior

+epre%int* NO-POQ din totalul racturilor maxilo-aciale

5ocali%*ri predilecte: Simf%* Gnghi +amur* ori%ontal* 7pof%a condilian*

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.lustrarea posibilit&=ilor de

#racturare a mandibulei >n#unc=ie de direc=ia de

ac=iune a agentului

traumatic

A 4 impact latero$lateral cu #ractur& median& de menton+ B 4 impact mentonier ?i

latero$lateral cu #ractura paramedian& a mentonului+ C 4 #ractura paramedian&

dreapt& de menton şi de ramură orizontală+ 5 4 impact cu direc=ie caudo$cranial&

la nivelul mentonului cu #ractura unghiului mandibular 

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C F t il dit

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C. Fracturile arcadei temporo-zigomatice

+epre%int* RNQ din totalul racturilormasivului acial

Examen clinic de ba%* Tipuri )rbito-sinusale $anterioare&

7rcada sub2ire $posterioar*&

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Exemplificare"

$ #ractur& de masiv #acial tip 7e ort .+ cu deplasare important& a ma'ilarului>nspre in#erior i posterior+ș

$#ractura de comple' !igomatic dreapta i arcad& temporo$!igomatic& dreaptaș

cu deplasare+$ #actur& cominutiv& de perete antero$lateral al sinusului ma'ilar stng-

D F t il l l

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D. Fracturile oaselor nazale 7sociere cu alte traumatisme r*bu<ire1 deviere1 ?nundare ale piramidei na%ale osibilitate de producere ?n os patologic $tumori& Examenul radiografc oarte important

7ateral radiographic vie@ o# a displaced nasal bone #racture in a patient

@ho sustained this in,ur6 because o# a punch to the #ace during a hoc1e6

gamehttp"//emedicine-medscape-com/article/2$overvie@

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E. Fracturile A.T.M.(articulatiatemporo-mandibulara)

+ar* i%olat*M asociat* marilor traumatisme 5uxa2ii asociate cu racturi 5uxa2ia central* cu ?nundarea codilului ?n cavitatea

glenoidal* 5uxa2ia mandibulei <i ractura stAncii 5uxa2ia posterioar* cu ractura canalului auditiv

extern 5uxa2ia intern* a condilului mandibular1 totdeauna

asociat* cu ractura

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7u'a=ie anterioar& (A) ?i posterioar& (B 4 punctat) a

articula=iei temporo$mandibulare

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CT" #ractura de condil mandibular 

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5islocatie Temporo$

mandib- bilaterala

http"//radiopaedia-org/articles/temporomandibular$,oint$trauma

Luxaţiacongenitalădeşold

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Luxaţia congenitală de şold

roces anormal de de%voltare al articula2ieicoxo-emurale ?n via2a intrauterin*

ai recvent* la ete ai des unilateral* Examenul radiografc 0 . util NOTĂ: de preferat a efectuat după

vârsta de 8 luni, după apariţia nucleuluicapului femural, înainte ca sugarul săînceapă să meargă !

Luxaţiacongenitalădeşold

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Luxaţia congenitală de şold )sifcarea si de%v. intar%iata a capului emural

$nucleul de osifcare apare cu intar%iere si estehipola%ic&1 iar cavitatea cotiloida este turtita si cuoblicitatea plaonului marita → proiectarea nucleuluicapului emural ?n cadranul inero-extern9supero-extern O)$0455$M normal ?n cadranul inero-intern@@

6ng+i acetabular modicat: normal este deC la na<tere <i B la un anM orice valori ?naara acestora sunt patologice

5uclei oso/i isc+io-pubienide+iscen'iindepartati cu aspect în 7g+ear* derac8 9 arc cervico-obturator intrerupt

Luxaţiacongenitalădeşold

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Luxaţia congenitală de şold

4rc cerico-obturator SH$5:O5-$54)0

 întrerupt Femur +ipoplazic de partea lu&at* 0istan'a d mai mare de RU mm $emur

laterali%at&1 iar distan'a + mai mic* de U mm

$emur mai aproape de linia Hilgenreiner&

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7u'a=ie congenital& de ?old (stg-)

Luxatiecongenitaladesold

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Luxatie congenitala de sold

Osteonecrozeleaseptice

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Osteonecrozele aseptice ;ezarea epizelor oaselor lungi apozelor /i

oaselor mici $tiopatogenez* neelucidat* $modifcari circulatorii

locale ce apar in perioada de crestere1 cand osifcarea nueste teminata&M

se produce resorbtie osoasa urmata de procesereparatorii lente:

  - se constatafsurari9microgeode9ragmentari9neregularitati de conturososM se asocia%a: distrugerea cartila>ului de crestere1largirea interlinului articular- condensari osoase1 sclero%ari ale supraetelor articulare

  -  - consecinte: deormari osoase1 predispo%itie la artro%a @ :raumatismele repetate 9 actor aorizant

OSTEONECROZEASEPTICE

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OSTEONECROZE ASEPTICE

rincipalele osteonecro%e aseptice:

8ecro%a aseptic* de cap emural )steocondrita tubero%it*2ii aterioare a tibiei )steocondrita rotulian* )steonecro%a capului metatarsianului !! )steonecro%a tubero%it*2ii calcaneului 'io%a >uvenil* )steonecro%a aseptic* de astragal

Necroza aseptică de cap femural=

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p p boala Legg-Calve-Perhtes-Waldenstrom

+adiologic Structur* osoas* de cap emural pr*bu<it*1 cu

rareac2ie1 cu aspect chistic $hemoragii& 7plati%are de nucleu cealic care d* aspect ?n

7tampon de agon8 'artila> de cre<tere neregulat Spa2iu articular normal9l*rgit de partea bolnav* Turtire <i ragmentare de cap emural

,up* -N ani de evolu2ie1 epif%* rotun>it*1 cu colemural scurtat ,iagnostic dieren2ial cu coxit* T'

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steonecro!& aseptic& a capului #emural (boala 7egg$

Calve$3erthes$Daldenstrom)

Osteonecrozadecapfemural

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Osteonecroza de cap femural

OsteonecrozaasepticadeCF(stg)

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Osteonecroza aseptica de CF (stg.)

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Osteocondrita tuberozităţii anterioare a

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tibiei= boala Schlatter-Osgood-Lannelongue

redilec2ie pentru vArsta de RB-RU ani reponderen2* la b*ie2i

'linic: tumeac2ie <i dureri +adiologic: (ragmentare de tubercul tibial anterior 5*rgirea spa2iului ocupat de cartila>ul de

cre<tere dintre tuberculul anterior <i metaf%* ,ecalcifcarea metaf%ei ,ep*rtarea vArului tubero%it*2ii tibiale cu

aspect ?n 7buza(tromp* de tapir8

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steocondrita tubero!it&=ii anterioare tibiale (boala Schlatter$

sgood$7anelongue)

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Osteocondrita rotuliana

= boala Sinding-Larsen-Johansohn

,enumit* <i patelita de cre<tere +otul* cu structur* alterat* osibilitate de evolu2ie pe os patologic

$tumor*&

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Osteomielita

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Osteo eta

roces inFamator osos locali%at metaf%ar cu

afnitate pentru oasele lungi Etiologie: Stalccul auriu 8"#$ pe

cale %ematgenă& rareri se ascia'a sistreptcc

"Arsta de predilec2ie: N-RP ani odifcari de structura si orma osoasa

Osteomielita

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Evolu2ie ,ebut:

Fără modifc*ri osoase decelabile radiolgic Edem de p*r2i moi

erioada de stare: din s*pt. C-a / tulbur*ricirculatorii ale osului1 cu modifcari radiologice: )steoporo%a p*tat*1 insular* eriosto%a: dup* BR de %ile de la debut )steoli%a: dup* BN-CO %ile de la debut )steonecro%a: apari2ia sechestrului osos

erioada de vindecare: osteosclero%a 'omplica2ii: extensie spre canal medular1

cartila>ul de cre<tere1 spa2iul articular1 par2imoi

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a!ele de evolu=ie ale osteomielitei" a 4 imagine radiologic& #&r&modi#ic&ri+ b 4 osteoporo!& insular&+ c 4 !one osteolitice (E) ?i

reac=ie periostal& (2)+ d 4 !one osteolitice (E)+ periosto!& (2)+

sechestru osos (F)

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steomielit& a ramurii ori!ontale a mandibulei" osteoporo!& insular&+

!one de osteoli!&+ sechestre osoase+ e#rac=ia marginii in#erioare

mandibulare pe unde se elimin& sechestre osoase

Osteomielita

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(orme clinico-radiologice Subacut* 'ronic*

7bces rodie (orm* pseudotumoral* (orm* fstuli%at*

(orme ?n raport cu vArsta )steomielita sugarului )steomielita adultului

(orme ?n raport de segment osos )steomielita vertebral* )steomielita oaselor scurte )steomielita alangelor 0 panari2iul

osos$extensie de la partile moi la os&

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Osteomielita

Osteomielita:

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,iagnostic dieren2ial

;n perioada de debut: +eumatism articular acut Sarcom Ewing Sarcom periostal

;n ormele cronice: )steosarcom osteocondensat

Siflis osos sclerogomos

Osteoartrita tuberculoasă

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%redilec'ie pentru articula'iile cu

solicitare mecanic* mare <coloanaertebral* /old genunc+i=

5ocali%are pe segmente cu cre<tere activ*1bogat vasculari%ate

Osteoartrita tuberculoasă

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Semiologie radiologic* odic*ri ale p*r'ilor moi

 Tumeac2ia articula2iei aectate <i a p*r2ilor moi odic*ri ale macrostructurii osoase# 

osteoporo%a1 osteoli%a1 osteonecro%a1

osteosclero%a1 periosto%a odic*ri de spa'iu articular 8eregularit*2i de contur ;ngustarea spa2iului articular ,ispari2ia spa2iului articular

odic*ri de orm* /i a& osos r*bu<iri1 deorm*ri !ncongruen2a artricular* 0 subluxa2ii o%i2ii vicioase 0 coxa valga1 ghibus

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Spondilita tuberculoasă

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p

Este locali%area cea mai recvent* atuberculo%ei osteo-articulare

Sediu de elec2ie ,RR-,RB 7ectare de B-C corpi vertebrali $dar <i U-V&

Spondilita tuberculoasă

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p

Semiologie radiologic* Stadiu de debut

)steoporo%* >uxta-discal* ensarea discului intervertebral Ero%iuni marginale de platouri vertebrale !magini cavitare

Stadiu avansat !magine radioopac* usiorm* perivertebral*-abces rece

in parti moi

"ertebre turtite1 deormate 7ngrenarea suprae2elor osoase restante 'io%* angular* ,ispari2ia discului intervertebral

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Tuberculo!& vertebral&

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Tuberculo!& vertebral&

(morbul 3ott)

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Tuberculo!& vertebral&

SPONDILITA TBC

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5iagnostic di#eren=ial radiologic"

Tumori vertebrale malignesteosarcom vertebral3lasmocitomul vertebral

Getasta!ele osteolitice

steocondrita vertebral& Scheuermann$Gau (adolescent+osteonecro!a aseptica+ cu hernii intraspongioase ale nucleului pulpos in tesutul osos adiacent al platourilor vertebrale noduliSchmorl+ corpi vert- trape!oidali/cunei#ormi →ci#o!a)

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steocondrita vertebral& Scheuermann$Gau ( osteonecro!a aseptica+ cu

hernii intraspongioase ale nucleului pulpos in tesutul osos adiacent al

 platourilor vertebrale

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S%O50I;I:4 :,

,iagnostic dieren2ial radiologic:

)steomielita vertebral* Hemangiomul vertebral Hernia de disc (racturile vertebrale Siflisul vertebral alorma2ii congenitale $hemivertebra

cuneiorm*& ,istrofi osoase

Spina ventoza:

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/Tuberculo%a osteoarticular* pe oasele

tubulare mici ale mAinii <i piciorului +adiologic )s m*rit1 de aspect suFat1 usiorm )steoporo%* eriosto%*

,iagnostic dieren2ial ,actilita siflitic* Encondromul osos anari2iul osos 'histul osos solitar Tumora cu mieloplaxe 7ngiomato%a oaselor mAinii

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http"//radiopaedia-org/cases/spina$ventosa$E

 Tumori osoase: benigne

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7pana>ul vArstelor tinere Stare general* bun*1 evolu2ie lent*1 ?ndelungat* 8u invadea%* 2esuturile din >ur

8u dau metasta%e1 nu recidivea%* postoperatorM +adiore%istente (racturi ?n os patologic

 Tumori osoase benigne

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+adiologic Sediu central9perieric (orm* rotund*9ovalar* 'ontur net delimitat SuF* osul 0 oedosto%* Sub2ia%* compacta ,eormea%* oasele (oarte rar reac2ie periostal*

a>oritatea imagini de osteoli%* -radiotransparenta

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A- E 4 osteoclastom+ 2 4 chist osos

esen=ial+ F 4 condrom+ 4 #ibromosi#iant

B- E 4 condroblastom+ 2 4 #ibrom

condromi'oid+ F 4 #ibromneosi#iant+ 4 granulom

eo!ino#ilic+ I 4 chist osos

anevrismal

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steom de sinus #rontal (tesut osos compact+ normal sau

mi't) 4 opacitate de intensitate mare

0 osteoamele" de predilectie in sinusurile #e=ei+ mai #recv-rontalJ

 pot det-#racturi osoase

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Hemangioame

0 se de!volta din capilarele osului

0  cavernos(vertebre)" rare#ierea si ingrosarea

(sclero!area)trabeculelor osoase+ vertebra cu margini

 bombate (”butoias“)

0capilar " transparenta centrala rotunda K transparente liniare

radiare

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Hemangiomde corp vertebral

Osteom osteoid

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$ase lungi (dia#i!a cel mai #recv-)

$ le!iune de mici dimensiuni"0 ocar unic (tesut osos tanar) rotund/ovalar nidus si0 hiperosto!a in ,ur (ingroasa compacta)

Osteom osteoid

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 Tumori osoase «semimaligne»

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,pdv clinic <i histopatologic au caracterebenigne care ?n evolu2ie se comport* caprocese maligne1 recidivAnd postoperator

'ategorii: 'ondroame  Tumora cu mieloplaxe

7damantinomul

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Adamantinom (ameloblastom) "$!one chistice+ transparente+$ care (in crestere) apasa si distrug

trabeculele spongiosei+

$ subtia!a si su#la corticala

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http"//@@@-google-ro/imgresLimgurlhttp"//@@@-dentalorg-com/@p$

content/uploads/2E//2-,pgMimgre#urlhttp"//@@@-dentalorg-com/amelobl

astoma-htm

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 Adamantinom

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 Tumora cu

celule brune(Osteoclastom)

-- predilectie pentru epifiza

oase lungi- transparentaomogena/septata

- sufla osul, il ingroasa indiametru, dar subtiaza si

lizeaza corticala

- 10% din cazuri: malignizare

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Tumoarea cu celule gigante+ cunoscuta si

sub numele de osteoclastom sau tumoare cu

mielopla'e se poate intalni in ambele iposta!e

" benigna sau maligna- 9ste diagnosticata la

 pacienti cu varsta cuprinsa intre 2 si de

ani+ se'ul #eminin #iind preponderent a#ectat

(I 4 NO)- Se locali!ea!a in proportie de  4 O in !ona meta#i!o$epi#i!ara a oaselor

lungi-0 ;adiogra#ic tumoarea apare ca o le!iune

radio$transparenta+ interesand e'tremitatile

oaselor lungi (mai rar oasele plate sau corpiivertebrali) si terminandu$se a nivelul

corticalei articulare- %ona de osteoli!a este

strabatuta de opacitati #ine+ liniare+ care$.

con#era aspectul de “baloane de sapun”

 Condrolastomul "0  este o tumora cartilaginoasa rara+ care a#ectea!a epi#i!ele+ inainte de

inchiderea cartila,elor de crestere- 9ste diagnosticat mai #recvent la baieti

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, g

cu varsta sub 2 de ani+ care acu!a dureri moderate+ persistente in !ona

articulatiei respective-  ;adiologic condroblastomul apare ca o !ona radio$transparenta+ de cele

mai multe ori limitata la nivelul epi#i!ei+ rotunda sau policiclica+ avnd

margini nete+ sclerotice si calci#icari intrale!ionale- .n ordinea

descrescatoare a #recventei sunt interesate #emurul pro'imal+ tibia

 pro'imal+ #emurul distal si humerusul pro'imal-

Osteocondrom

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0 tu-datorata de!voltarii unei insule aberante ale cartila,ului de crestere- 9ste

descoperit de obicei in decadele a doua si a treia de viata+ atunci cand

devine simptomatic prin compresiunea partilor moi-

  $ 3oate a#ecta orice os care se de!volta prin osi#icare encondrala+ dar se

locali!ea!a cel mai #recvent in !ona meta#i!ara a #emurului si humerusului-0 ;tg-"

 $ Calci#icari intr$un condrom (cartila, hialin)"

$Gase lobulate+ sesile+ atasate oaselor lungi+ #alangelor+ metacarpiene"transparenta inomogena0 caracteristici"$ continuitatea dintre corticala osului normal si cea a tumorii- Aceasta a,uta

la diagnosticul di#erential cu sarcomul parosteal

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steocondrom"

 Tumori osoase maligne primare

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!nciden2* mare la vArsta tAn*r* ?ntre RO-BN ani reponderen2* la sexul masculin Evolu2ie rapid*1 inva%iv* 7lterarea st*rii generale etasta%e +ecidivea%* postoperator Histologic 0 celule atipice

 Tumori osoase maligne primare

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5ocali%are mai recvent* ?n metaf%a oaselorlungi

'ontur imprecis1 <ters ,istrugerea compactei +eac2ie periostal* sub dierite orme

Mielom multiplu- varste mai inaintate

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- calota craniu, stern, coaste, bazin: multiple lacune

rotund-ovoide→con#luea!a" e'tind lacuna$ #ara sclero!a sau reactie periostala

$ mielom solitar" oase lungi

$ dg- 5i#-" canale vasc-+

ga! din colon+ meta osteolitice

https"//@@@-google-ro/searchLPmultipleKm6elomaMsourcelnmsMtbmischMsa

steosarcom

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steosarcom osteolitic

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steosarcom

osteolitic(#emur)

steosarcom osteolitic (humerus)

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steosarcom osteosclerotic

(ST909<.C)"

$ is a primar6 malignant tumor arising in bone+ the

tumor cells producing immature bone+ or osteoid

0 i b # i

steogenic Sarcoma (osteosarcoma)

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0 is a bone #orming cancer 0  .t is the most #rePuent t6pe o# bone

tumour and is most common bet@een the

ages o# EI to 2I-0 ver O o# tumours are located in the

metaph6sis + the most common sites are

the bones around the 1nee @hich account

#or O o# cases0  steosarcomas var6 greatl6 in

radiological and pathological #eatures and

there#ore needs care#ul diagnosis to

di##erentiate this #rom other bone tumours-

0  Gost are high grade intramedullar6osteosarcomas+ about IO are lo@ grade

lesions

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:$ra6 and CT demonstrate e'pansile mass centered in the #emur @ith

e'tensive osteoid matri' and cortical destruction

http"//@@@-boo1terra-com/inde'-php/5iagnosticQ;adiolog6/Gusculos1eletalQ.maging

/TumorsQBasic/steosarcoma

Osteogenic Sarcoma(osteosarcoma)

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;adiograph sho@ing an osteol6tic and osteoblastic intra$medullar6 tumor characteristic

o# osteosarcoma- rom 7a6#ield R et al- Clin Ged 3athol- 2J E" II$I-

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0 ;tg-A3 pelvis sho@s mar1ed sclerosis o#

the le#t ilium and a large+ sclerotic so#t

tissue mass-0 CT demonstrates the sunburst or

e'plosive dense osteoid matri' emanating

#rom the ilium and

0 G;. sho@s the large heterogeneous so#ttissue mass-

ST9SA;CG

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steosarcoma o# the distal radius in a dog-

Codmans triangle is #ormed b6 the elevation o#

the periosteal reaction (arro@s+ lateral

radiograph)

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steosarcom 9@ing 4 (dia#i!a oase lungi) #a!e de evolu=ie"0la inceput li!a corticalei+ urmata de periosto!a lamelara “bulb de ceapa”

07a #inal" li!a os completa

0 meta" ganglionare+ osoase si pulmonare

0 <ota" con#u!ie la debut cu osteomielita ac- (#ebra+ leucocito!a+ in#lamatie

locala+ durere)

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E!ing sarcoma of femur" rontal radiograph and lateral radiographs o# the #emur demonstrate mottled+ osteol6tic lesion (blue circle) @ith poorl6 marginated edges

in the diaph6sis o# the bone-

There is sunburst periosteal reaction (red circle) and lamellated periosteal reaction

(@hite arro@s)-http"//@@@-learningradiolog6-com/archives2N/CDO22N$9@ing

O2Sarcoma/e@ingscorrect-html

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Sarcom Ewing

Sarcom 9@ing

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http"//@@@-radiolog6assistant-nl/en/pbcbabd/bone$tumor$ill$de#ined$osteol6tic$

tumors$and$tumor$li1e$lesions-html

Sarcom parostal"

A parosteal  osteosarcoma is a sub

t6pe o# osteosarcoma and arises

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t6pe o# osteosarcoma+ and arises

#rom the outer la6er o# periosteum-

http"//@@@-bonetumor-org/tumors$bone/parosteal$osteosarcoma

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3arosteal sarcoma arising #rom the

 posterior margin o# the #emur @ith a large

so#t tissue mass and dense osteoid matri'-

Tumoriosoasemalignesecundare-

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 Tumori osoase maligne secundare

metastazele

re%en2a ?n antecedente a unui cancer primar ecanisme de producere din aproape ?n aproape

<i diseminare hematogen*

Metastaze osoase osteosclerotice

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Getasta!e osteolitice cu #ractur& Getasta!e osteolitice de ba!in

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http"//@@@-medscape-org/vie@article/I2E

NQF

 Artrite

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odifc*ri de spa2iu articular odifc*ri de p*r2i moi

odifc*ri de extremit*2i osoase

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a!ele de evolu=ie ale artritei acute" E 4 spa=iu articular

normal+ 2 4 dung& de doliu (distructie osoasa sub

supra#ata articulara)+ F 4 ero!iuni de supra#e=e+ 4

anchilo!& osoas& precoce cu reac=ie periostal&+ I 4 artrit&

cronică constituit&

Periartrita scapulo-humerala

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Guta- tofi gutoşi

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Poliartrita cronică evolutivă

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odifc*ri de p*r2i moi odifc*ri de structur* osoas*

odifc*ri de spa2iu articular odifc*ri de po%i2ie ale oaselor mAinilor

POLIARTRITA REUMATOIDA(PR)

inonime:

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inonime:

0*oliartrita cronica eolutia (*>)0 Artrita reumatoida0@eumatism poliarticular cronic progresi

0  P#$ oala inflamatorie sistemica cronica% ce poate afectamultiple tesuturi si organe % in principal articulatiile% producandinflamatia memranei sino&iale 'sino&ita( % care progreseazafrec&ent spre cartila)ul articular pe care*l distruge % conducand laanc+iloza articulara0  poate% de asemenea% produce inflamatia difuza pulmonara%

pericardica% pleurala% cat si leziuni nodulare % mai ales in tesutulsucutanat su piele"0 desi cauzele P# sunt necunoscute% autoimunitatea  )oaca un rolimportant in cronicitatea si progresia olii"

'O!IARTRITA RE#MATOI<A('R)0 suerinta caracteri%ata de o inFamatie cronica

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suerinta caracteri%ata de o inFamatie cronicainfltrativ-prolierativa a sinovialei articulare

0   clinic : artrita pre%enta la mai multe articulatii1deunde si numele de poliartrita

0  le%iunile osteo-articulare sunt simetrice1 perierice1iar daca este netratata sau nu raspunde la tratament

va conduce la distructii articulare si deormitatidat. ero%iunilor cartilagiilor si distructiilor osoase

0 'ca RQ din populatia globului este aectata de +0 "arul incidentei se intalneste in decadele a patra si a

cincea ale vietii.0 (emeile ac aceasta boala de B-C ori mai des ca

barbatii.

POLIARTRITA REUMATOIDA(PR)

  riteriile 4e 4iagnostic al 'R : utilizate de mai #ine de 8E ani si aufost ela#orate pe un grup larg de pacieni la care #oala eolua in mediede H ani.

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In prezent- acestea nu mai satisfac eigenele actuale ale diagnosticului*@ precoce6 el putin doua criterii sunt in discutie su# acest aspect:prezenta eroziunilor si factorul reumatoid (@).Ero3iunile articulare pot fi astazi depistate in etapa pre-radiografica,prin metode cum ar fi  ultrasunetele si rezonanta magnetica, iarrecomandarea este de a introduce terapia remisia inainte de aparitia

acestora pe imag @tg*e de alta parte, cu toate ca $actorul Reu-atoi4 (= o imunoglo#ulina)este un indicator de persistena a #olii, acesta nu apare in toate cazurile,iar specificitatea sa este scazuta.!in anul 2??? au fost introduse in practica metodele pentru depistarea

anticorpilor anti-peptid ciclic citrulinat (*), care se #ucura deaantajul precocitatii, specificitatii si predicti#ilitatii eolutiei #olii (su#aspectul aparitiei eroziunilor articulare.)  Atitudinea potriita ar fi 4eter-inarea conco-itenta a $R sianticorpilor anti,' pentru recunoaterea *@ precoce si ealuarea

potentialului eoluti al acesteia

POLIARTRITA REUMATOIDA(PR)

0 leziunile in poliartrita reumatoida sunt distructie, afectand toate

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  leziunile in poliartrita reumatoida sunt distructie, afectand toateelementele articulare: sinoiala, capsula, cartilajele, epifizele osoase,

ca si formatiunile periarticulare (musc3ii, tendoanele).0  leziunea de#uteaza la nielul mem#ranei sinoiale articulare, caredeine granuloasa, #urjoneaza (inmugureste) si, de aici, prindecartilajul articular, pe care-l distruge.0in locul tesutului distrus apare tesut fi#ros, care face sa adere celedoua suprafete osoase, diminuand miscarile si producandu-se

anc3iloza fi#roasa partiala.0  totodata, osteoporoza - care este un semn precoce in poliartritareumatoida - conduce la formarea cariilor osoase in epifize(microgeode). In timp, a apare osificarea prin infiltrari calcice,determinand sudarea etremitatilor osoase, si deci, anc3iloza osoasadefinitia

0 capsula si tendoanele or prezenta edem si musc3ii se or atrofia

POLIARTRITA REUMATOIDA(PR)

Simptomatologie$

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In eolutia #olii se deose#esc patru stadii:0 stadiul I (polialgic), dominat de durere70  stadiul II (esudati), in care, alaturi de durere, aparredoarea articulara, tumefactiile si deformarile articulare(apare eudat articular si periarticular)0  stadiul III (proliferati), dominat de atrofii musculare,anc3iloze si su#luatii70  stadiul I (terminal, reprezentand ultima faza dineolutia #olii), apare dupa 8-"E de ani de la de#ut,#olnaul deenind un inalid care-si petrece toata iata inpat.

POLIARTRITA REUMATOIDA(PR)

  !upa intensitatea osteoporo3ei, a 4e9or-arilor articulare si aanchilo3elor se deose#esc:

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anchilo3elor , se deose#esc:

-stadiul precoce (I), cu discreta osteoporoza, tumefiere de parti moiperiarticulare si capacitate functionala pastrata7 alteori, modificarileradiologice pot lipsi complet

-stadiul moderat (II), cu osteoporoza, microgeode, ingustareaspatiului articular, durere, redoare, atrofie musculara redusa si

capacitate functionala inca normala7-stadiul seer (III), cu osteoporoza, leziuni distructie intinse, mariatrofii musculare si deformari articulare (su#luatii) si capacitatefunctionala limitata7

-stadiul terminal (I), cu osteoporoza, leziuni distructie mari,anc3iloza osoasa, atrofii musculare intinse, mari deformari articulare

si infirmitate importanta, #olnaul fiind o#ligat sa stea in pat sau infotoliu si neputandu-se ocupa de sine

POLIARTRITA REUMATOIDA(PR)

Ra4iogra9ic(continuare).

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Ra4iogra9ic(continuare).

  - osteoscleroza (osteofite la #aza falangei a II-a su# forma de noduli+e#erden= ecrescente osoase marginale pe etremitatea proimala afalangei ) – se ad r-grafic si clinic

0  *@ eolueaza treptat , in pusee, cu etensie la articulatiile mari(centripet):  - articulatia radio-carpiana, cot, metatarso-falangiene, glezna,genunc3i, sold, coloana erte#rala(mai ales cerical)

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PCE$ A 4 bloc compact al oaselor carpiene cu mici geode+ B 4 modi#ic&ri de structur& ale #alangelor (E 4 spa=iu articular

>ngustat+ 2 4 osteo#it marginal+ F 4 !one osteolitice)+ C 4

stadiu #inal (deviere cubital& ?i anchilo!& #ibroas&)

Poliartrita reumatoida

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'O!IARTRITA RE#MATOI<A('R)

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'O!IARTRITARE#MATOI<A('R)

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Semnele distrugerii si in#lamatiei

(8S si .;G) la articulatia II*a

metacarpofalangiana$

$Sageata subtire" modi#icari

ero!ive

$ sageata groasa"sinovitain#lamatia membranei

sinoviale (ingrosata)$,S ( a)plan longitud- si b) plan

transv- ) 4 evid- distructii si

in#lamatie$#-$ A'ial TE$p obtinute (c)

inainte si dupa (d) CG. " arata

sinovita$3lan coronal TE$p (e) inainte de

CG." ero!iunile osoase

'O!IARTRITA RE#MATOI<A

*oliartrita cr .secundara: surine dupa un @AA care nu se indeca, ci

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pse cronicizeaza

  - lez. articulare au sediul la articulatiile mari (genunc3i si sold),#oala etinzandu-se centrifug (articulatiile mici periferice find multtimp respectate)

Joala lui till-3auffard: este o *@ care se intalneste la copii7 pelanga afectarile articulare (mai discrete si mai frec. la artic. mari –col.cericala si artic. sacro-iliace) apar 3ipertrofii ggl. sisplenomegalie. /a adult se numeste sindrom elt4

 Artrita psoriazica (8"-8F din pacientii cu psoriazis) : mai ales artic.

interfalangiene distale, cu resor#tia falangelor ungueale indromul aplan: asociatia *@-pneumoconioza stadiul III (noduli

pulmonari mari, rotunzi)

Coxartroza

ensare de spa2iu articular

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p 2

'ondens*ri ale suprae2elor osoase )steofte marginale ?n gulera< ,eminerali%are one de osteoli%* insulare subcondrale 0

geode

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Coxartroz.$ A 4 osteosclero!& >n oglind& ?i pensare

 polar& superioar& de spa=iu+ B 4 pensare polar& in#erioar& cu pintene marginal+ C 4 pensare ?i >ngustare a'ial& de spa=iu

articular+ 5 4 stadiu #inal (coloane osteo#itice constituite)

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The coxart+rosis a##ects men and @omen ePuall6 and @ith ePual #rePuenc6-

The disease is usuall6 relapsing" 3hases o# active in#lammation alternate @ith

s6mptom$#ree phases- The increasing ,oint destruction leading to pain+ gradual

sti##ness+ #unctional disabilit6 and a signi#icant loss o# li#e-

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Clasi#icare lui GcA#ee ?i Gagerl (cele U tipuri)" E 4

#ractur& prin compresie 4 vertebr& cunei#orm&+

2 4 #ractur& e'plo!iv&

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Clasi#icare lui GcA#ee ?i Gagerl"

 F 4 #ractur& e'plo!iv& complet& de corp vertebral

4 #ractur& prin hiper#le'ie anterioar&

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Clasi#icare lui GcA#ee ?i Gagerl" I 4 #ractur& cu

deplasare ?i hiper#le'ie >n spatele 773+ U 4 traumatism

 prin transla=ie+ cu sau #&r& rota=ie a'ial& a coloanei

3atogene!a

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herniei dedisc

S'ON<I!ITA ANHI!O@ANTA

Sinoni-e. maladia trKmpel-Jec3tere5$spondilartrita anc3ilopoetica

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p p p

>ste o artrita cronica inflamatorie, autoimuna, ce afecteaza inprincipal sistemul ligamentar erte#ral si articulatiile miciintererte#rale, articulatiile iliace si uneori articulatiile proimale alemem#relor 

*redilectie pentru seul masculin (adultul tanar)

;odificarile radiologice apar la catia ani de la de#utul clinic si

tre#uie cautate la articulatiile sacro-iliace si la articulatiile miciposterioare de la col.ert.

S'ON<I!ITA ANHI!O@ANTA ;odificarile radiologice: la inceput sunt prinse simetric artic.sacro-iliace, cu D stadii de eolutie:

  - stadiul I – contururi articulare sterse si spatiul articular largit

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p g

  - stadiul II – osteoliza pe suprafetele osoase articulare si sclerozaperiarticulara

  - stadiul III – anc3iloza osoasa, cu a#senta spatiului articular  ulterior sunt prinse articulatiile mici posterioare de la coloana lom#ara,

de unde se etind la celelalte segmente /a ni. orpilor erte#rali: la inceput col. /om#ara, apoi toracala si

cericala:  - osteoporoza difuza a corpilor erte#rali, apoi aplatizarea platourilor

ert., rectitudinea col. ert.(disparitia cur#urilor fiziologice), frecentcifoza

  - in perioada de stare si anc3iloza: osificarea aparatului ligamentarerte#ral (toate ligam.) → punte osoasa continua intre marginile

erte#rale(sindesmofit, diferit de osteofitul din spondiloze)7 progresise osifica toate ligam.: ligam. gal#ene dintre lamelele erte#rale, intreapofizele spinoase, la ni. ligamentului longitud. ant. →rtg. de fa%a:col.de #am#us, sine de tramai7 discurile interert. nu sunt ingustate

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Boala Bechtere@ 4 3ierre Garie 4 Strumpel (#a!e de evolu=ie

dup& Vrebs)" E 4 aspect normal+ 2 4 artrit& sacro$iliac&

simetric&+ F $ artrit& sacro$iliac& simetric& cu osteoli!& ?i

osteosclero!&+ 4 #a!& de anchilo!& osoas&

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a!e de evolu=ie ale bolii Bechtere@ 4 3ierre Garie 4

Strumpel" A 4 coloan& vertebral& cu aspect “a,ustat la

rindea”+ B+C 4 osi#icarea ligamentului vertebral anterior ?i

ligamentelor interapo#i!are ?i intervertebrale+ 5 4 aspect

>n “coloan& de bambus”

S'ON<I!ITA ANHI!O@ANTA

modificarile se pot etinde la articulatiile costo-erte#rale, articulatiilemari ale mem#relor (sold si umar)

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mari ale mem#relor (sold si umar)

  - @tg. de profil: osificarea aparatului ligamentar

erte#ral - sindesmofite

S'ON<I!ITA ANHI!O@ANTA

I@; ale articulatiilor scro-iliace: imagini

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I@; ale articulatiilor scro iliace: imagini

18-p inainte a) si dupa #) ;I ---en3ancement in dreapta = sacroileitaactia

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Sacroileita

S'ON<I!ITA ANHI!O@ANTA

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oloana de #am#us

Spon4ilo3a 4e9or-anta

/a coloana 5erte7rala - se poate localiza:

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p

  - la articulatiile dintre corpii erte#rali  - la articulatiile mici dintre apofizele artic sau

  - la am#ele  Afecteaza col. Lombara si cervicala (au cea mai mare mo#ilitate) @adiologic:

  - osteofite marginale multiple pe conturul ant-lat. al platourilorerte#rale → aspect in cioc de pasare de pradaB(col. /om#ara)

  - osteoscleroza platourilor erte#rale (ingrosarea si crestera opacitatiiplatourilor ert.)

  - discul intererte#ral pastrat, dar cu inaltime scazuta, calcificari sau

acuum p3enomena(discita)  - ingustarea gauriilor de conjugate interert.: la ni. erical cu

#ra3ialgie(-L si L-H) sau cefalee occipitala ("-D, D-9)

S3<5.7%A C9;.CA7A

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spondilodiscita(vacuum phenomenon)

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(a) T2D Sagittal image o# G;. sho@s disc herniation at multiple levels @ith

grade E anterolisthesis o# 7I over SE vertebra (b) CT Sagittal bon6$

reconstruction sho@s vacuum phenomenon in all the intervertebral discs o#


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