Curs 5 - 1 Osteoarticular

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Transcript of Curs 5 - 1 Osteoarticular

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    Catedra de RadiologieUMF Iuliu Hatieganu Cluj-Napoca

    Angelica Chiorean

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    Morfopatologic Hipertrofie sinoviala papilomatoasa / panus

    Distructie cartilaginoasa Distructie osoasa

    Luxatii / subluxatii

    Anchiloza

    Afectare viscerala

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    Tesuturi moi

    Aspect

    Tumefactie simetrica, fisiforma (sinovita, colectie) Tumefactie asimetrica (noduli reumatoizi, bursite)

    Tehnici

    Rgr standard / rgr in imersie

    Ecografie cu 7,5 MHz

    IRM SE, STIR, Ga

    Scintigrafie

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    Cartilajul

    Uniform ingustat (prezent in 20% din cazuri dupa

    un an de evolutie) - la inceput prin activitateaenzimatica a sinovialei

    Distructii asimetrice

    Ingustarea spatiului articular

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    Osoase

    Osteoporoza juxta-articulara generalizata

    Eroziuni marginale (vizibile > 1 an de evolutie) Chiste subcondrale

    Osteoliza epifizelor (panusul sinovial) aspectpencil in cup, rar aspect mutilant

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    Modificari in alinierea articulara

    Luxatii

    Subluxatii

    Anchiloza Fibroasa

    Osoasa in 20% din cazuri (carp, tars)

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    Maini Rgr. comparativa de maini cartea devizita in PR Debut

    IFP, MCF II si III, intereseaza toate articulatiile, rar IFD

    osteoporoza in banda

    Evolutie Eroziuni - vizibile mai bine pe fata radiala a capului

    metacarpienelor si falangelor, stiloida cubitala Deviere

    Cubitala a degetelor 2-5 , in butoniera, gat de lebada

    Luxatia medio-palmara a carpului

    Anchiloza - carp

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    Rolul Rgr.

    Diagnostic +

    Stadializare

    Urmarirea evolutiei

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    Stadiu Modificari RxI Tumefiere

    Osteoporoza in banda

    Microchiste

    MicrocalcifieriII I +

    Eroziuni subcondrale - osteolize mici

    Ingustari de spatiu articularIII II +osteolize >, distructii osoase

    Subluxatie, telescopareIV III +

    Anchiloza, modificari mutilante

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    Coloana cervicala Poate ameninta viata bolnavului

    Odontoida

    subluxatie-luxatie posterioara (rgr in flexie a coloanei cervicale), >2,5 mm intre odontoida si arcul anterior al C1

    subluxatie laterala, deplasare craniala

    eroziuni, liza

    Cervical mediu

    artrita interapofizara distructiva

    listeza vertebrelor C4 C5 stenoza canal rahidian (IRM, CT)

    spondilodiscita

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    Rgr. in flexie luxatie C1/C2

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