radiology 5th year, 4th lecture (dr. salah mohammad fatih)
DESCRIPTION
The lecture has been given on May 24th, 2011 by Dr. Salah Mohammad Fatih.TRANSCRIPT
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joints
Prepared by Dr.Salah Mohammad FatihMBChB,DMRD,FIBMS(radiology)
Lecture no 4
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Gout
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Radiological features of gout
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Joint infection
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Most often due to pyogenic bacterial infection or TB.
Usually only one joint affected. Synovial biopsy or exam. of the joint fluid is
necessary for identification of infecting organism
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Usually due to staph. Aureus. Rapid destruction of the articular cartilage
followed by destruction of the subchondral bone & cause peri articual soft tissue swelling.
Earliest radiological finding is joint effusion, do US, you can do US guided aspiration of the joint fluid.
If Dx is still in doubt , then MRI advisable
Pyogenic infection
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Radiological features of pyogenic joint infection
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There is decrease in cartilage width in the left hip, and cortical indistinctness in the left acetabulum with subarticular cyst formation.
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Hip& knee are the most commonly affected peripheral joints.
Spine involved in 50% of cases.
TB arthritis
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Localized osteoporosis. Cartilage erosion usually occur late for that
resion , at 1st joint space is preserved. Margional errosion. At late stage there may be gross
disorganization of the joint with calcified debris near the joint.
Radiological features
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Neuropathic joint (Charcot joint)
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•Common causes;
•DM•Spinal cord injury•Myelomeningocele/ syringomyelia.•Alcohol abuse.
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Radiological features
•classic picture of a Charcot joint. It demonstrates the five Ds:
•increased or normal density,• joint distension (effusion), •bony debris.• joint disorganization• joint disassociation.
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•lateral translation of the tibia relative to the femur;• a destructive arthropathy with loss of cartilage width and fragmentation, especially of the medial tibial plateau; •large effusion containing bony debris.
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•Changes seen in the feet in the pt with diabetic neuropathy.
•Prominent feature is Resorption of the bone ends & calcification of the arteries in the feet often present
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complete obliteration of the cartilage width and destruction with very abundant fragmentation at this joint.
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Avascular(aseptic) necrosis
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• Also known as osteonecrosis, is where there is death of bone due to interruption of the blood supply.
• It occur most commonly in the intra-articular portions of bones & is associated with numerous underlying condition including.
• Steroid therapy.• Collagen vascular diseases.• Radiation therapy.• Sickle cell disease.• Exposure to the high pressure environment e.g. deep-
see divers
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X-ray finding
•Increased density of the subchondral bone with irregularity of the articular contour or even fragmentation
• A charactristic lucent line may be seen just beneath the articular cortex.
•The cartilage space may be preserved until secondary OA changes occur.
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left hip joint;increased density centrally and flattening of the femoral head in the weight-bearing region, as well as the crescent sign or subchondral fracture.
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MRI
•Is imaging modality of choice.
•It can show abnormality when the X-ray is normal & signal pattern allow specific Dx to be made.
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The MR, shows that this patient has bilateral avascular necrosis of the hip joints, with a low-signal rim surrounding the necrotic segments
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osteochondritis
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•Is a group of condition in which no associated cause for avascular necrosis can be found.
•Osteochondritis now regarded as being due to impaired blood supply associated with repeated trauma.
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Perthe’s disease
•Is avascular necrosis of the femoral head in children.
•seen generally between ages 4 and 8, when the vascular supply to the femoral head is most at risk.
• Males are affected more than females. •Bilateral in 10 percent of patients.
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X-ray finding
•The first radiographic sign may be effusion.
• Later, increased density, fragmentation and flattening of the ossification center & lucent areas within it
• •Metaphyseal irregularity & short wide
femoral neck.
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The left femoral capital epiphysis is dense, has lucent areas within it, and is flattened. This left hip is laterally subluxated,
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Other forms of osteochondritis
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•Kienbock’s disease = avascular necrosis of lunate bone.
•Freiberg’s disease = avascular necrosis of metatarsal head.
•Kohler’s disease = avascular necrosis of navicular bone of the foot.
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There is increased density and collapse of the lunate
Kienbock's disease
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Freiberg’s disease
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Osgood-schlatter’s disease = avascular necrosis of tibial tuberosity .
Fragmentation of tibial tuberosity
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Kohler’s disease = avascular necrosis of navicular bone of the foot.
Increased density with irregularity in the out line
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Slipped femoral epiphysis
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.
• age range (10 to 16 years of age)
• Males are more commonly affected than females.
• bilateral 20 percent of the time, but rarely symmetric.
• Slipped epiphyses almost always are directed posteromedially.
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Radiological finding
• The epiphysis itself appears shorter due to the posterior slippage.
• The epiphyseal plate itself appears wider, with less distinct margins
• The epiphysis is also slightly more medially placed, it can be demonstrated by drawing a line along the lateral femoral neck. This line should intersect a portion of the femoral head in the normal individual. In a slipped epiphysis, the line will either not intersect the femoral head, or will intersect a smaller portion of it.
• The slip is best appreciated in lateral film of the hip
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The left femoral capital epiphysis appears slightly shorter than does the right, with an apparent widening of the epiphyseal plate
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Developmental dysplasia of the hips (DDH or CDH)
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developmental dysplasia of the hips (CDH or DDH)
•female: male = 6:1
•70% occur on the left side, Bilateral involvement occur in 5%
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Radiographic finding
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Thank you