Prepared by Dr.Salah Mohammad Fateh MBChB,DMRD,FIBMS(radiology) Lecture no 4.
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Transcript of Prepared by Dr.Salah Mohammad Fateh MBChB,DMRD,FIBMS(radiology) Lecture no 4.
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JOINTS
Prepared by Dr.Salah Mohammad FatehMBChB,DMRD,FIBMS(radiology)
Lecture no 4
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Types of arthritis
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Degenerative arthritis (OA) Is the commonest form of arthritis. Changes occur secondary to wear &
tear of the articular cartilage.
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Radiological features of OA
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Inflammatory arthritis
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Rheumatoid Arthritis
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Radiological features of RA
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OA• Joint space narrowed max.
at wt bearing site• Erosion do no occur.
• Subchondral sclerosis may be seen.
• Sclerosis is a prominent feature.
• No osteoporosis.
• No peri articular soft tissue swelling
RA• Joint space narrowing uniform.
• Erosin is characteristic feature.
• Subchondral sclerosis is not a feature.
• Sclerosis not a feature unless there is secondary OA.
• Osteoporosis often present
• Peri articular soft tissue swelling
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OA RA
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Ankylosing spondylitis
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Radiological features
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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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Pyogenic infection
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
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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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TB arthritis
Hip& knee are the most commonly affected peripheral joints.
Spine involved in 50% of cases.
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Radiological features
Localized osteoporosis. Cartilage erosion usually occur late ,for
that reason , at 1st joint space is preserved.
Marginal erosion. At late stage there may be gross
disorganization of the joint with calcified debris near the 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 characteristic 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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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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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