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RADIOLOGIE RADIOLOGIE OSTEO-ARTICULARAOSTEO-ARTICULARA
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OS LUNG:SCHITE ANATOMICEOS LUNG:SCHITE ANATOMICE
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METODE IMAGISTICE
•RADIOGRAFIA STANDARD/DIGITALA;
•TOMOGRAFIA PLANA ;
•ULTRASONOGRAFIA=>P.MOI ARTICULARE
•CT;
• IRMN;
•SCINTIGRAMA OSOASA;
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ANATOMIEANATOMIE
RADIOLOGICARADIOLOGICA:
STRUCTURA
HAVERSIANA
NORMALA
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SEMIOLOGIE SEMIOLOGIE RADIOLOGICA OSOASARADIOLOGICA OSOASA
I.MODIFICARI STRUCTURALEI.MODIFICARI STRUCTURALE
1.REZORBTIA:1.REZORBTIA: - -osteoporozaosteoporoza
-osteoliza-osteoliza
-osteonecroza-osteonecroza
2.OSTEOCONDENSAREA (OSTEOSCLEROZA):2.OSTEOCONDENSAREA (OSTEOSCLEROZA):
-PERIOSTOZA-PERIOSTOZA
-ENDOSTOZA-ENDOSTOZA
-SPONGIOSCLEROZA-SPONGIOSCLEROZA
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OSTEOPOROZA:STUDIU COMPARATIV PE RADIOGRAFIE STANDARD.
NORMAL
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SEMIOLOGIE RADIOLOGICA:OSTEOPOROZA
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OSTEOLIZA
CIRCUMSCRISA DE
LIZEREU DE SCLEROZA:
CHIST OSOS
ESENTIAL
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SEMIOLOGIE RADIOLOGICA:
OSTEOLIZA
VERTEBRALA
(metastaze osoase)
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NECROZA ASEPTICA A CALCANEULUI-EVOLUTIE
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SEMIOLOGIE OSOASA
II.II.MODIFICARI DE ORGANOGENEZAMODIFICARI DE ORGANOGENEZA::
-hiperostoza-hipostoza-hiperostoza-hipostoza
-oedostoza-oedostoza
-scoliostoza-scoliostoza
-hiperplazie-hipoplazie-hiperplazie-hipoplazie
-aplazie-agenezie-aplazie-agenezie
DISTROFIIDISTROFII
DISPLAZIIDISPLAZII
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SEMIOLOGIE RADIOLOGICA:osteoporoza,osteocondensare,scoliostoza,oedostoza
RAHITISM FLORID PSEUDARTROZA
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SEMIOLOGIE:
SCOLIOSTOZA,
OSTEOPOROZA,
OSTEOSCLEROZA
(remaniere complexa)
BOALA PAGET
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PATOLOGIE OSOASAPATOLOGIE OSOASA
•TRAUMATISME:-fracturi,luxatii,entorse;
•BOLI INFLAMATORII:acute,cronice;osteite,osteomielite;
•TUMORI:benigne;potential maligne;maligne:primitive,meta.
•NECROZE ASEPTICE
•DISPLAZII;DISTROFII
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PATOLOGIEPATOLOGIE OSTEO-ARTICULARA OSTEO-ARTICULARAAFECTIUNI ARTICULARE ACUTE:
-nesupurate=>RAA
-supurate=>artrite (stafilo/streptococ);
AFECTIUNI ARTICULARE CRONICE:
-nesupurate:PR,SA,artroze,metabolice,neuropatice;
-supurate:tbc.
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OSTEOMIELITA
•ETIOLOGIE:stafilococ auriu,streptococ;ETIOLOGIE:stafilococ auriu,streptococ;
•MECANISM:-embol microbian=>art.nutritiva;MECANISM:-embol microbian=>art.nutritiva;
-contiguitate (fracturi deschise,artrite etc);-contiguitate (fracturi deschise,artrite etc);
•SEDIU: -os lung=>metafize (debut);SEDIU: -os lung=>metafize (debut);
-extenzie diafizara,epifizara,articulara;-extenzie diafizara,epifizara,articulara;
-monostica,monotopa:tibie,femur cca 75%-monostica,monotopa:tibie,femur cca 75%
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OSTEOMIELITAOSTEOMIELITA
ASPECTE RADIOLOGICEASPECTE RADIOLOGICE
•DEBUT:DEBUT:osteoporoza localizata metafizar;dg.dificil=>IRMN,osteoporoza localizata metafizar;dg.dificil=>IRMN,
scintigrafie polinucleare marcate Ga-67;scintigrafie polinucleare marcate Ga-67;
STARESTARE:-osteoliza “patata”;:-osteoliza “patata”;
-tumefactie de parti moi;-tumefactie de parti moi;
-necroza septica=>halou + sechestre;-necroza septica=>halou + sechestre;
-periostita=>mansoane,grosiera,extenzie diafizara;-periostita=>mansoane,grosiera,extenzie diafizara;
-abces subperiostal-abces subperiostal
-fistulizare in partile moi periosoase-fistulizare in partile moi periosoase
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OSTEOMIELITA ACUTA:DEBUT=>STARE
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OSTEOMIELITA:
EXTENZIA
DIAFIZO-METAFIZARA
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OSTEOMIELITA
EVOLUTIE:-VINDECARE=>cicatrici fibroscleroase,geode;
-reactivare==>CRONICIZARE:domina reactia
endostala/periostala;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
Rx.standard
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OSTEOMIELITA CRONICA;DEFORMARI
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OSTEOMIELITA:
COMPLICATII:
artrita sold,necroza
capului femural,
subluxatie coxo-fem.
secundara,tulb.de
crestere femur.
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OSTEITA/MIELITA POST -INTERV.CHIRURGICALA(fractura)
Reactie
periostala
osteoliza
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OSTEOMIELITA
FFORME PARTICULARE
ABCES OSOS CENTRALABCES OSOS CENTRAL(BRODIE):
-SEDIU:tibie,metafiza superioara;
-ASPECT Rx:-geoda ovala,inel scleroza;fara sechestre/r.periost.
-EVOLUTIE:cronica,cu pusee de acutizare;
PANARITIU OSOS(osteita/mielita=>contiguitate de la p.moi;
-SEDIU:-falange terminale
-ASPECT RX:-liza osoasa din afara spre canal med.;
-fara reactie periostala.
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PANARITIU OSOS:EVOLUTIE NEFAVORABILA
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TUBERCULOZA OSTEO-ARTICULARA
MECANISM:reactivare BK in sinoviala artic.mari=>adolescent, adult.ANAT.PAT.:osteoartrita supurata cronica.
ASPECTE RX:
-DEBUT:-osteoporoza regionala;-pensare spatiu articular;
STARE:-geode/carii osoase”in oglinda” pe extremit.artic -osteoliza progresiva=>caverne epifizare=abcese reci articulare; EVOLUTIE:-prabusiri articulare;disparitia spatiului articular; “topiri osteolitice”=>sechestre mici;-ankiloze;-blocuri osoase-art.
FORME TOPOPGRAFICEFORME TOPOPGRAFICE
1).TBC VERTEBRALA=MORB POTT:-vertebre pereche;”fus” paravertebral(abces rece fuzat=>psoas);-bloc vertebral/cifoza;
2)COXITA(coxalgia):distructie cap/acetabul;anchiloza/scurtare/ protruzie in pelvis;
3)”TUMORA ALBA “DE GENUNCHI=artrita,fistule,ankiloza.
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MORB POTT:LEZIUNI MINIMALE LOMBARE
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MORB POTT DORSAL:osteoliza,tasare,”fus” paravertebral
Abces rece
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BLOC VERTEBRAL SECUNDAR MORBULUI POTTBLOC VERTEBRAL SECUNDAR MORBULUI POTT
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TUMORI OSOASEBENIGNE BENIGNE MALIGNE PRIMAREMALIGNE PRIMARE
OSTEOM OSTEOM OSTEOSARCOMOSTEOSARCOM
FIBROM FIBROM FIBROSARCOM FIBROSARCOM
HEMANGIOM HEMANGIOM ANGIOSARCOM ANGIOSARCOM
CONDROM CONDROM CONDROSARCOMCONDROSARCOM
T.MIELOPLAXET.MIELOPLAXE MIELOM MIELOM
MALIGNE SECUNDARE:MALIGNE SECUNDARE:
metastaze, metastaze,
leucemii,leucemii,
limfoamelimfoame
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OSTEOMTESUT OSOS ADULT,SUPER-COMPACT;BENIGN;TESUT OSOS ADULT,SUPER-COMPACT;BENIGN;
CLINIC:lent evolutiv;NU METASTAZEAZACLINIC:lent evolutiv;NU METASTAZEAZA
SEDIU:sinus frontal;oase cranieneSEDIU:sinus frontal;oase craniene
ASPECT RX:osteocondensat,compact,intens opac,omogen,oval/ASPECT RX:osteocondensat,compact,intens opac,omogen,oval/
rotund,contur policiclic;rotund,contur policiclic;
DG.DIFERENTIAL:meningiom osteoplasticDG.DIFERENTIAL:meningiom osteoplastic
VARIANTAVARIANTA:OSTEOMUL OSTEOID=>unii anat/patologi sustin :OSTEOMUL OSTEOID=>unii anat/patologi sustin ca este o displazie sau osteita cronica si nu tumora…!Sediu:osca este o displazie sau osteita cronica si nu tumora…!Sediu:os
lung=>diafiza;ASPECT:-focar osteolitic 4-10 mm((NIDUS),culung=>diafiza;ASPECT:-focar osteolitic 4-10 mm((NIDUS),cusechestru mic central;hiperostoza /scleroza in jur,bombeazasechestru mic central;hiperostoza /scleroza in jur,bombeazasubperiostal,in partile moisubperiostal,in partile moi
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OSTEOM DE SINUS FRONTAL
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FIBROM
TESUT CONJUNCTIV NEOSIFICAT-INTRAOSOS
SEDIU:-METAFIZAR/DIAFIZAR=OASE LUNGI;
-MANDIBULA=>”EPULIS”
ASPECT RX:-ZONA OSTEOLITICA,CU INEL NET DE
SCLEROZA IN JUR;
-CONTUR CICLIC;
-OSUL ADIACENT NEMODIFICAT;
-FARA REACTIE PERIOSTEALA
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OSTEOFIBROM
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TUMORI OSOASE BENIGNE
FIBROM OSOSFIBROM OSOS CHIST OSOS ESENTIALCHIST OSOS ESENTIAL
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OSTEOCONDROM
TESUT CARTILAGINOS NEOSIFICAT
SEDIU:OASE TUBULARE=FALANGE,METACARPIENE;
TIPURI:CENTRAL=ENCONDROM;
PERIFERIC=ECCONDROM;
ASPECTE RX:-lacuna osteolitica ovalara,net delimitata,cu inel
fin de sleroza periferica;absenta reactiei periostale
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CONDROAME MULTIPLE-BOALA OLLIER
ECCONDROM
ENCONDROM
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TUMORA CU MIELOPLAXE(CELULE GIGANTE)
SEDIU:EPIFIZA OASE LUNGI(TIBIA,FEMUR),OS PLAT;
ASPECTE RX:-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;tumo-ra se extinde in partile moi.
DG.DIFERENTIAL:-MIELOM SOLITAR,ENCONDROM,
CHIST OSOS ESENTIAL
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TUMORA
CU
MIELOPLAXE
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TUMORA
CU
MIELOPLAXE
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OSTEOSARCOMOSTEOCIT MATUR;MONOSTIC;MONOTOP;agresiv,metastaze
TIPURI:-OSTEOLITIC;OSTEOPLASTIC
T.OSTEOLITIC:-SEDIU:metafiza os lung;ASPECT RX:perferic sau central la debut=>lacuna osteolitica,contur neregulat;pinten sarcomatos CODMANN(“triunghiul mortii”)=reactia periostala limitata +decolarea periostului /distructie periostala;
T.OSTEOPLASTIC:ASPECT RX:osteoliza + reactie periostala
exuberanta,cu aspect radiar(“spiculi perpendiculari/diafiza”,in perie”);respecta epifiza;
EVOLUTIE:-METASTAZEAZA RAPID(pulmon,creer,ficat);
-fracturi patologice;invazia articulatiei vecine.
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OSTEOSARCOM:
TIPURI SI VARIANTE
RADIOLOGICE
OSTEOLITIC
CENTRAL PERIFERIC,RADIAR
OSTEOCONDENSANT
OSTEOLITIC
PERIFERIC
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-UL MORŢII
PINTENCODMANN
OSTEOSARCOM
TIP OSTEOLITIC,
VARIANTA PERIFERICA
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OSTEOSARCOM EXTINS LOCO-REGIONAL(fractura)
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OSTEOSARCOM OSTEOPLASTIC
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OSTEOSARCOM:
PERIFERIC
TIP RADIAR
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SARCOM PAROSTAL
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CONDROSARCOMTESUT CARTILAGINOS(..CONDROM..?);EXOSTOZE
OSTEOGENICE(B.OMBREDANNE).
SEDIU:METAFIZE,BASIN,COASTE;
ASPECT RX:-OSTEOLIZA +CALCIFICARI AMORFE IN
MASA TUMORALA=>INVAZIE DE PARTI MOI.
FIBROSARCOM OSOS
TESUT CONJUNCTIV;DG.DIF.DIFICIL(BIOPSIE !)
TIP CENTRAL=OSTEOLIZA OS LUNG;
TIP PERIFERIC=SARCOM PERIOSTAL(PAROSTAL)
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ChondrosarcomChondrosarcomChondrosarcomChondrosarcom
Osificare enchondralăOsificare enchondrală
Scintigrafie Tc.99 pirofosfat
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ChondrosarcomChondrosarcomChondrosarcomChondrosarcom
RADIOGRAFIERADIOGRAFIE IRMN,T 1/T 2IRMN,T 1/T 2
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MIELOM(PLASMOCITOM)
ESTE CEA MAI FRECVENTA TUM.MALIGNA PRIMARA
ORIGINE:-CEL.PLASMOCITARE MEDULARE(monoclonala)
-MARKER:proteinurie BENCE JONES.
SEDIU:-MADUVA HEMATOGENA=>ADULT
TIP MULTIPLU=>B.RUSTITKI-KHALER;
TIP SOLITAR=>PLASMOCITOM(rara);
ASPECT RX:-ZONE OSTEOLITICE=“PANOU GAURIT”
(TIPIC LA CRANIU);TASARI VERTEBRALE;COASTE,OS LUNG CU ASPECTE “SUFLATE”;OSTEOZA DIFUZA.
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MIELOM MULTIPLUMIELOM MULTIPLU
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MIELOM MULTIPLU
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TUMORI MALIGNESECUNDARE
METASTAZE OSOASE(CANCER OSOS METASTATIC)
CLINIC:CANCER DECLARAT/OPERAT SAU OCULT:
(cauta sin,prostata,pulmon,tiroida,rinichi etc).
TIPURI:OSTEOLITICE,OSTEOPLASTICE,MIXTE.
OSTEOLITICE:-osteoliza progresivape c.vert.,basin,coaste: zone transparente,lqacunare,fara delimitare,fara r.periostala; fracturi secundare=>paraplegii,pareze etc.
OSTEOCONDENSANTE:-zone dense ,patate(“pete de ceara” descrise de REBOUL),confluate;sediu pe basin,vertebre;rare= cancerul prostatei,vezicii,sinului.
MIXTE:-alternanta liza/condensare pe aceleasi sedii topogr.
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METASTAZE OSOASE:A)OSTEOLITICE;B)OSTEOPLASTICE
A B
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METASTAZE OSTEOLITICE
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METASTAZE OSOASE OSTEOPLASTICE:pete de ceara(Reboul)
CANCER MAMAR T-4
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NECROZE ASEPTICE
MECANISM:-tulburarile vascularizatiei locale; -post-traumatice; -embolii gazoase (boala de cheson).
1)OSTEONECROZA CAPULUI FEMURAL=boala LEGG- CALVE-PERTHES):-distructie progresiva a capului fem.;spatiu articular pastrat;evolutie spre anchiloza;subluxatie,coxartroza;
2)OSTEONECROZA TIBIALA ANTERIOARA=boala OSGOOD SCHLATTER-LANELONG):-cioc,”nas de tapir”,decolare si osteo sinteza(realipire) sau detasare de fragment(“soricel..”).
3)VERTEBRALA=cifoscolioza juvenila(b.SCHEUERMANN)=
vertebre tasate,cuneiforme,scolioza,cifoza,hernii nucleu pulpos intraspongios(noduli SCHMORL)(platouri ancosate);evolutie=>spondilartroza precoce
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NECROZA
ASEPTICA A
NUCLEULUI DE CRESTERE A
CAPULUI FEMURAL
FRAGMENTARE
PULVERIZARE
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NECROZA ASEPTICA A CAPULUI FEMURAL
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NECROZA ASEPTICA A CAPULUI FEMURAL:DEBUT
Forma adultului
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NECROZA
ASEPTICA A
CAPULUI
FEMURAL:
TOMOGRAFIE
PLANA
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NECROZA ASEPTICA NECROZA ASEPTICA A CAPULUIA CAPULUI
FEMURAL;SECHELEFEMURAL;SECHELE:
SUBLUXATIESUBLUXATIE
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Artrite cronice nesupurate
1.SPONDILITA ANKILOZANTA(B.STRUMPEL-BECHTEREV)
DEBUT:sacro-iliac,periferic(genunchi),vertebral(C7-T1)
APECTE RX:DEBUT-ingustare,stergere,largire spatiu art.;-condensarea osului subchondral;-osteoporoza;
STARE -osificari ligamentare;-sindesmofite(ligam.perivertebrale anrtero-laterale);
TERMINAL(IV):-osificarea ap.ligamentar=>ANKILOZARE==> “bat de bambus”,”sina de tramvai”;-cifoza dorso-lombara larga=> “pozitia schiorului”;
-artrite/artroze/ankiloze a articulatiilor mari:coxo-fem.,genunchi.
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SPONDILITA ANKILOZANTA:SPONDILITA ANKILOZANTA:MODIFICARI SACROILIACE
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SPONDILITA ANKILOZANTA:SINDESMOFITE CERVICALE
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SPONDILITA ANKILOZANTA:SINDESMOFITE
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SPONDILITA ANKILOZANTA:COL.VERTEBRALA
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SPONDILITA ANKILOZANTA;EXTENZIE
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Artrite cronice nesupurate2.POLIARTRITA REUMATOIDA.
CLINIC:-b.artritica cu teste inflam.pozitive;etiol.incerta=> componenta autoimuna probabila.Sediu la debut:artic.miciDEBUT:-artic.falangiene,carpiene;-osteoporoza;largirea sp.art.-chisturi,microgeode subchondrale,pe epifize;
EVOLUTIE:-subluxatii falangiene,deviatii cubitale “in grifa”,
ghiara;’”feuille au vent”;-ankiloza fibroasa/punti osoase inter- falangiene;osteoscleroza sec.-extenzie la alte articulatii:picior, vertebrale,coxo-fem.;genunchi etc.
SD.CLINICE INCLUZIND P.R.:1)Sd.Still-Chaufard:copil,spleno-megalie,adenopatii periferice,febra;2).Sd.Felty:idem,adult;3)Sd. Reiter-Fiesenger-Leroy:PR,uretrita,conjunctivita(posibil virala.?); 4)Sd.Kaplan-Colinet:PR +pneumoconioza;5)Sd.Goujerot-Sjögren: PR.-artic.mari+uscare secretii salivare,lacrimare(xerostomie)
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POLIARTRITA
REUMATOIDA:
DEBUT/STARE
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POLIARTRITAREUMATOIDA STADIUL II
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POLIARTRITA REUMATOIDA:PERIOADA DE STARE
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POLIARTRITA REUMATIDA:STADIU AVANSAT
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POLIARTRITA REUMATOIDA:MINA IN “ feuille au vent”POLIARTRITA REUMATOIDA:MINA IN “ feuille au vent”
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ARTROZA DEFORMANTA
B.DEGENERATIVA-primitiva=>virsta 2-a-3-a..;-secundara:=> post-traumatica,necrotica,post-inflamatorie,metabolica etc.
ASPECTE RX:-ingustarea interliniului;scleroza subchondrala; modificari epifizare:”slefuire”,dezrotunjire”;osteofitoza margin,: productii osoase spiculare pe insertii ligamentare,tendinoase=> “ciocuri de papagal”;-osificari capsulare;fen de vacuum articular (vid-CT,IRMN=fen descris de DITTMAR -FERGUSON:degene- rescenta cartilagiului=>grasime,aer ?!)
SEDII PREFERENTIALE:-coloana vertebrala(spondiloza defor)
--sold(coxartroza);genunchi(gonartroza)
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SPONDILARTROZA DEFORMANTASPONDILARTROZA DEFORMANTA
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ARTROZA DE GENUNCHI(“GONARTROZA”)
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ARTROZA AVANSATA
DE
GENUNCHI
(GONARTROZA)
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COXARTROZA IN STADIU AVANSAT(ANKILOZA)
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HERNIE DISCALA L-5/S-1HERNIE DISCALA L-5/S-1:RADIO.DIGITALA & CT.:RADIO.DIGITALA & CT.
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CT-VERTEBRO
DISCALA:
HERNIE
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IRM : Hernie discală IRM : Hernie discală IRM : Hernie discală IRM : Hernie discală
Protruzie discală focalăProtruzie discală focalăProtruzie discală focalăProtruzie discală focalăSectiune orizontala sagitala