Radiology 5th year, 4th lecture (Dr. Salah Mohammad Fatih)


Published on

The lecture has been given on May 24th, 2011 by Dr. Salah Mohammad Fatih.

Published in: Health & Medicine
1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Radiology 5th year, 4th lecture (Dr. Salah Mohammad Fatih)

  1. 1. Lecture no 4<br />joints<br />Prepared by Dr.Salah Mohammad Fatih<br />MBChB,DMRD,FIBMS(radiology)<br />
  2. 2. Gout<br />
  3. 3.
  4. 4. Radiological features of gout<br />
  5. 5.
  6. 6.
  7. 7. Joint infection<br />
  8. 8. Most often due to pyogenic bacterial infection or TB.<br />Usually only one joint affected.<br />Synovial biopsy or exam. of the joint fluid is necessary for identification of infecting organism<br />
  9. 9. Usually due to staph. Aureus.<br />Rapid destruction of the articular cartilage followed by destruction of the subchondral bone & cause periarticual soft tissue swelling.<br />Earliest radiological finding is joint effusion, do US, you can do US guided aspiration of the joint fluid.<br />If Dx is still in doubt , then MRI advisable<br />Pyogenic infection<br />
  10. 10. Radiological features of pyogenic joint infection<br />
  11. 11. There is decrease in cartilage width in the left hip, and cortical indistinctness in the left acetabulum with subarticular cyst formation.<br />
  12. 12. Hip& knee are the most commonly affected peripheral joints.<br />Spine involved in 50% of cases.<br />TB arthritis<br />
  13. 13. Localized osteoporosis.<br />Cartilage erosion usually occur late for that resion , at 1st joint space is preserved.<br />Margionalerrosion.<br />At late stage there may be gross disorganization of the joint with calcified debris near the joint. <br />Radiological features<br />
  14. 14.
  15. 15. Neuropathic joint (Charcot joint)<br />
  16. 16. Common causes;<br />DM<br />Spinal cord injury<br />Myelomeningocele/ syringomyelia.<br />Alcohol abuse.<br />
  17. 17. Radiological features<br />classic picture of a Charcot joint. It demonstrates the five Ds: <br />increased or normal density,<br />joint distension (effusion), <br />bony debris.<br />joint disorganization<br /> joint disassociation.<br />
  18. 18. <ul><li>lateral translation of the tibia relative to the femur;
  19. 19. a destructive arthropathy with loss of cartilage width and fragmentation, especially of the medial tibial plateau;
  20. 20. large effusion containing bony debris. </li></li></ul><li>Changes seen in the feet in the pt with diabetic neuropathy.<br />Prominent feature is Resorption of the bone ends & calcification of the arteries in the feet often present<br />
  21. 21. complete obliteration of the cartilage width and destruction with very abundant fragmentation at this joint.<br />
  22. 22. Avascular(aseptic) necrosis<br />
  23. 23. Also known as osteonecrosis, is where there is death of bone due to interruption of the blood supply.<br />It occur most commonly in the intra-articular portions of bones & is associated with numerous underlying condition including.<br />Steroid therapy.<br />Collagen vascular diseases.<br />Radiation therapy.<br />Sickle cell disease.<br />Exposure to the high pressure environment e.g. deep- see divers<br />
  24. 24. X-ray finding<br />Increased density of the subchondral bone with irregularity of the articular contour or even fragmentation<br />A charactristic lucent line may be seen just beneath the articular cortex.<br />The cartilage space may be preserved until secondary OA changes occur.<br />
  25. 25. left hip joint;<br />increased density centrally and flattening of the femoral head in the weight-bearing region, as well as the crescent sign or subchondral fracture.<br />
  26. 26. MRI<br />Is imaging modality of choice.<br />It can show abnormality when the X-ray is normal & signal pattern allow specific Dx to be made.<br />
  27. 27. The MR, shows that this patient has bilateral avascular necrosis of the hip joints, with a low-signal rim surrounding the necrotic segments<br />
  28. 28. osteochondritis<br />
  29. 29. Is a group of condition in which no associated cause for avascular necrosis can be found.<br />Osteochondritis now regarded as being due to impaired blood supply associated with repeated trauma.<br />
  30. 30. Perthe’s disease<br />Is avascular necrosis of the femoral head in children.<br />seen generally between ages 4 and 8, when the vascular supply to the femoral head is most at risk.<br />Males are affected more than females. <br />Bilateral in 10 percent of patients. <br />
  31. 31. X-ray finding<br />The first radiographic sign may be effusion. <br />Later, increased density, fragmentation and flattening of the ossification center & lucent areas within it<br />Metaphysealirregularity & short wide femoral neck. <br />
  32. 32. The left femoral capital epiphysis is dense, has lucent areas within it, and is flattened. This left hip is laterally subluxated, <br />
  33. 33. Other forms of osteochondritis<br />
  34. 34. Kienbock’s disease = avascular necrosis of lunate bone.<br />Freiberg’s disease = avascular necrosis of metatarsal head.<br />Kohler’s disease = avascular necrosis of navicular bone of the foot.<br />
  35. 35. There is increased density and collapse of the lunate<br />Kienbock's disease<br />
  36. 36. Freiberg’s disease<br />
  37. 37. Osgood-schlatter’s disease = avascular necrosis of tibial tuberosity .<br />Fragmentation of tibial tuberosity<br />
  38. 38. Kohler’s disease = avascular necrosis of navicular bone of the foot.<br />Increased density with irregularity in the out line<br />
  39. 39. Slipped femoral epiphysis<br />
  40. 40. .<br />age range (10 to 16 years of age)<br />Males are more commonly affected than females.<br /> bilateral 20 percent of the time, but rarely symmetric.<br />Slipped epiphyses almost always are directed posteromedially. <br />
  41. 41. Radiological finding<br />The epiphysis itself appears shorter due to the posterior slippage.<br />The epiphyseal plate itself appears wider, with less distinct margins<br /> 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. <br />The slip is best appreciated in lateral film of the hip <br />
  42. 42.
  43. 43. The left femoral capital epiphysis appears slightly shorter than does the right, with an apparent widening of the epiphyseal plate<br />
  44. 44.
  45. 45.
  46. 46. Developmental dysplasia of the hips (DDH or CDH)<br />
  47. 47. developmental dysplasia of the hips (CDH or DDH) <br />female: male = 6:1<br />70% occur on the left side, Bilateral involvement occur in 5%<br />
  48. 48. Radiographic finding<br />
  49. 49.
  50. 50.
  51. 51.
  52. 52. Thank you<br />