INFEKSI TULANG DAN SENDI

Preceptor:
Dr. Rima Saputri, Sp.Rad

KOAS PERIODE 24 JUNI – 29 JUNI 2019

KEPANITERAAN KLINIK RADIOLOGI

RUMAH SAKIT UMUM DAERAH JEND. AHMAD YANI METRO
FAKULTAS KEDOKTERAN
UNIVERSITAS LAMPUNG
2019
OSTEOMIELITIS
Lesi destruksi dan reaksi
periosteal pada
osteomielitis akut
OSTEOMIELITIS AKUT

 Tampak pembengkakan jaringan lunak di daerah genu

kanan
 Tampak lesi litik berbatas tegas dan lesi sklerotik
pada 1/3 distal os femur kiri
OSTEOMIELITIS AKUT

Acute osteomyelitis of the second metatarsal

 The hallmarks of bone destruction (white arrow)
 Periosteal new bone formation (black arrow)
OSTEOMIELITIS KRONIS

 Tampak pembengkakan jaringan lunak di daerah genu

kanan
 Tampak destruksi 1/3 distal os femur posterior kanan
 Tampak lesi litik berbatas tegas dan lesi dominan
sklerotik dengan tepi irreguler pada 2/3 distal os
femur kanan
 MASTOIDITIS

 Sellulae dan pneumatisasi mastoid kanan berselubung

 Tidak tampak lesi lusen dan destruksi (Colesteatoma)
 Tegmen timpani dalam batas normal
SPONDILITIS TB

• Increased kyphotic curve of thoracic

spine with angulation at T9-10 level.
• Collapsed T9 and T10 vertebral bodies
with obliteration of T9-10 intervertebral
disc space.
• Bilateral paraspinal soft tissue (arrows).
• Diagnosis: Tuberculous spondylitis
 RADIOGRAPHS: EROSIONS

• Terdapat area lusen dalam aspek lateral badan vertebra yang berdekatan (erosi)
• Penyempitan ruang diskus
• Central lucency with surrounding sclerosis suggesting chronic infection
RADIOGRAPHS: ENDPLATE DESTRUCTION
RADIOGRAPHS: ATYPICAL FEATURE
 CT : CALCIFICATION

Noncontrast axial CT
Pembesaran abses psoas dengan kalsifikasi sentral.;Temuan ini menegakkan diagnosis spondilitis TB.
 CT: BONY DESTRUCTION

Noncontrast axial CT
Kerusakan badan vertebral yang luas menyebabkan fragmen tulang.
OSTEOARTHRITIS (OA)

OA of hip
• Marginal osteophyte formation (solid white arrows)
• Subchondral sclerosis (solid black arrows)
• Subchondral cyst formation (dotted black arrows)
PRIMARY OA OF HIP AND KNEE
PRIMARY OA OF THE HANDS
SECONDARY OA OF HIP

There is a marked discrepancy between the

two hips with severe and advanced
osteoarthritis of the right hip (black arrow)
and a relatively normal left hip (white arrow).
CHARCOT ARTHROPATHY (NEUROPATHIC JOINT)

The hallmark findings of a Charcot joint, however, are

fragmentation of the bones surrounding the joint, which
produces numerous small, bony densities within the joint
capsule (white arrows), and joint space destruction (black
arrows). The most common cause of a Charcot joint of
the knee is now diabetes.
 CALCIUM PYROPHOSPHATE DEPOSITION DISEASE

A, Hook-shaped bony excrescences along the 2nd and 3rd metacarpal heads are a common finding in CPPD (white arrows). The
radiocarpal joint is narrowed (black arrow). B, In the wrist, characteristic findings include calcification of the triangular fibrocartilage
(white arrow), separation of the scaphoid (S) and the lunate (L) (scapholunate dissociation), and collapse of the capitate (C) toward
the radius (black arrow), called scapholunate advanced collapse (SLAC).
EROSIVE OSTEOARTHRITIS

The erosions are typically centrally located

within the joint (black arrows) and, combined
with the small osteophytes associated with the
disease (white arrows), produce what has been
called the gull-wing deformity.
 RHEUMATOID ARTHRITIS (RA)

A, In the hand, the erosions of metacarpalphalangeal (MCP) joints (white arrows)

B, In the wrist, erosions of the carpals (dotted white arrow), ulnar styloid (solid white arrow), and narrowing of
the radiocarpal joint space (solid black arrow) are commonly seen.
 GOUT

The hallmark of gout is the sharply marginated Olecranon bursitis in gout.

erosion, which may have a sclerotic border (white • Large soft tissue mass around elbow shown by white
arrows). The overhanging edges of gouty erosions have arrows
been called rat-bites. • Erosions adjacent to the elbow joint (black arrow)
 PSORIATIC ARTHRITIS

Telescoping of one phalanx into another (pencil-in-cup deformity)

ANKYLOSING SPONDYLITIS

• Solid white arrow points to bony overgrowth at the ischial

tuberosity
• Bilaterally symmetrical sacroiliitis is the hallmark of
ankylosing spondylitis. This eventually leads to bony fusion
or ankylosis of the sacroiliac joints until they disappear as
joints altogether (solid black arrows)
• The symphysis pubis is also ankylosed (dotted black arrow)
ANKYLOSING SPONDYLITIS OF SPINE

• Bony bridges joining the corners of adjacent

vertebrae called syndesmophytes (white arrows).
• Progressive ossification connecting adjacent
vertebral bodies produces the bamboo-spine
appearance.