LIZA L.

VIDAL MICHELLE EVANGELISTA MAICO SALVADOR ATEFEH VAEZ OSMENA PINATED

RADIOGRAPHIC PATHOLOGY

PAGETS DISEASE
RADIOGAPHIC FINDINGS OF PAGETS DISEASE. Pagets Disease, described by Sir, James Paget in 1877, is characterized by thickening of the bony cortex, coarsening of trabeculae and enlargement of affected bones, radiographic abonormalities reflect the accelerated bone turnover in lytic, blastic, and mixed phases. What Is the cause of Pagets Disease? most authorities favor a viral etiology, base on identification of intranuclear inclusion bodies. This theory is unproven. How does Pagets Disease present clinically? the disease is often asymptomatic and discovered incidentally on radiographs obtains from another reason. Pain and bony enlargement are most common clinical symptoms. An increasing hat size is a classic historical clue to pagets disease. Patient also may present with neurologic complications of disease.

PAGETS DISEASE
Is Pagets disease more common in blacks than whites? The disease is much common in whites. Pagets disease is qute rare in blacks and asians and is most common in northern europe. Which skeletal sites are most commonly affected by pagets disease? Lumbar spine: increase density of the entire vertebral bosy or its margins results I classic ivory vertebra or picture frame vertebra respectively. Skull: multiple rounded areas of increased density result in the classic COTTON-WOOL SPOT on skull radiographs Pelvis: thickening of the iliopectineal line is considered to be both specific and sensitive for pagets disease. Involvement of the entire pelvis or an entire hemipelvis is common. Femur, Tibia: when long bone are affected, involvement typically starts at the end of the bone and eventually progresses to involve the entire bone. The leading edge of the lytic phase of the disease soon ensues, characterized by cortical thickening coarsening of trabeculae and increase bony density. Bowing of long bones is also common

PAGETS DISEASE
What is BANANA FRACTURE Pathologic fracture is known camplication of Pagets disease. Such as fracture usually are incomplete, involving the convex side of bowed long bones. Also known as FISSURE FRACTURES, they resemble the complete breaks that result from bending banana. Pathologic fractures may also be completed and displaced, owing to the relatively weak pagetic bone. Describe the appearance of Pagets Disease on MRI It is variable. Most cases are associated with markedly abnormal, heterogenous marrow signal which can be mistaken for a malignant neoplasm if not correated with plain films. Hence the significance of the MRI findings on pagets disease ahould be approach with caustion, and plain films are mandatory when thid diagnosis is being considered. A CT scan is superior MRI for demonstrate the classic skeletal findings on pagets disease.

MRI

X-RAY

Magnetic Resonance Imaging SAGITTAL SECTION OF THE SKULL

Caption: Paget's disease. Coloured magnetic resonance imaging (MRI) scan of a sagittal section through the skull of a 60 year old patient with Paget's disease. The skull has become thickened (white). Paget's disease, or osteitis deformans, is a chronic bone disease that results in enlarged or deformed bones. The rate of bone reabsorption and formation become out of balance, leading to structurally disorganised, weaker and enlarged bone. Treatment is not usually required, but can be with painkillers or bisphosphonates, which slow the abnormal process and promote growth of normal bone.

MRI OF THE LUMBAR SPINE

Paget's disease. Magnetic resonance image (MRI) of the lumbar spine of a woman aged 43 years suffering from Paget's disease, showing deformation of some of the vertebrae (rectangular column). Paget's disease is a chronic disease of bone, which becomes thickened and deformed by excessive and disorganised resorption and formation of bone. Parts of the skeleton most often affected are the skull, spine, and pelvis. Pagetic bone may be hard or soft but either type fractures easily. Severe pain may be caused by the bone itself, by an associated fracture or by arthritis in nearby joints.

COLOURED X-RAY PELVIS SUFFERING FROM PAGETS DISEASE

Paget's disease. Coloured X-ray showing the pelvis of a person suffering from Paget's disease or osteitis deformans. The pelvic bones have a mottled appearance due to their increased porosity. Paget's disease is a chronic bone disease which occurs in middleaged and elderly people. The normal organisation and balance of bone absorption and creation becomes disrupted leading to thickened deformed bones. The bones' increased porosity makes them liable to fracture, while the hip joints are more vulnerable to arthritis. Treatment, while not usually necessary, is with painkillers, the hormone calcitonin to promote healthy bone formation or surgery.

OSTEOARTHRITIS
What is inflammatory arthritis Inflammatory arthritis include rheumatoid arthritis and the rheumatoid variants (psoriatic arthritis, reiters disease, ankylosing spondylitis. The feature common to all of these disorders is inflammatory pannus that erodes articular cartilage and bone. What is the difference between degenerative joint disease (DJD) and osteoarthritis (OA) none these terms are used intrachangeably. Some favor osteoarthritis because itis implies an imflammatory may acommpany DJD but is not a primary features of the disease. What are the most common sites of involvement of OsteoArthritis knee: medial cmpartment >patellofemmoral>lateral compartment Hips: usually superolateral joint space narrrowing Hands: first carpometacarpal joint, distal interphalengeal joint (DIP) and proximal interphalangeal joint (PIP) FEET: metatarsophalangeal joint, (MTP) of great toe, midtarsal joints Shoulder- glenohumeral and acromioclavicular (AC) joints

False-colour X-ray showing osteoarthritis

False-colour frontal X-ray showing osteoarthritis in both human knee joints. In each leg, the bone at top is the femur (thigh bone), which articulates against the tibia (shin bone) at the knee. The smaller of the lower bones is the fibula. In a normal, healthy joint the heads of the femur and tibia would not appear in direct contact, as they do in this image. Narrowing of the joint space due to loss of cartilage (the working surface of the joint) is a typical X-ray feature in osteoarthritis. The condition is associated with mechanical wear and is most common in persons over 50 years of age.

Arthritis of the spine

Arthritis of the spine. Coloured profile magnetic resonance imaging (MRI) scan of the spine of a patient with cervical osteoarthritis, a degenerative joint disease. The front of the body is at left. Osteoarthritis damages the cartilage between the vertebrae (yellow blocks), moving them close together. As the cartilage is worn away new bone grows, a process known as osteophytosis. This limits the flexibility and movement of the neck. Treatment is with antiinflammatory drugs, physiotherapy, and in severe cases, surgery.

SCOLIOSIS
Define scoliosis Scoliosis is coronal plane deformity of the spine What is the most common cause of scoliosis Scoliosis is idiopathic in about 70% of cases, but idiopathic scoliosis remain diagnosis of exclusion. While an exhaustive diagnostic work-up is not necessary for all patient. Consideration must always be given to the presence of underlying cause of spinal curvature. Common causes of congenital scoliosis Vertebral anomalies, which include segmentation anomalies (block vertebra), hemivertebrae, and butterfly vertebrae.

 What is the difference between structural and nonstructural curves. Structural curves are fixed deformities that will not reduce with lateral bending . Nonstructural curves are flexible and can completely reduce with lateral bending. They are usually milder in degree than structural curves.

SCOLIOSIS CT-SCAN
Scoliosis. Coloured computed tomography (CT) scan of the body of an adolescent girl with scoliosis. The spine is at centre. Scoliosis is a lateral (sideways) curvature of the spine. This condition usually starts in infancy or adolescence, and is most often seen in girls. Its cause is not known, although occasionally it may be due to a congenital abnormality of the vertebrae, polio or an injury. Treatment depends on the severity of the curvature. In mild cases none is needed, but others may require immobilisation of the spine or surgery to pin the vertebrae in a straight line.

SCOLIOSIS X-RAY
Coloured X-ray (front view) of the abdomen of a patient aged 90, showing curvature (scoliosis) of the spine due to weakening and demineralisation of the vertebral bones.

MRI SCOLIOSIS
Curvature of the spine. Coloured magnetic resonance imaging (MRI) scan of a frontal section through the body of a 22-year-old woman with kyphoscoliosis, a progressive deformity of the spine. The spine is at centre, the pink blocks are the vertebrae of the spine. Kyphoscoliosis results in an exaggeration of the normal curvature of the spine and a sideways curvature. This condition usually starts in childhood or adolescence, and is most common in girls. Its cause is unknown, although occasionally it may be congenital, or due to polio or an injury. In mild cases no treatment is needed, but in severe cases, as here, surgery is used to straighten and pin the spine.

Scoliosis MRI

KYPHOSIS
In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching posture. While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities, neurological compromise and, in the more severe cases, significantly shortened life-spans. These types of high end curves typically do not respond well to conservative treatment, and almost always warrantspinal fusion surgery, which can successfully restore the body's natural degree of curvature. The Cobb angle is the preferred method of measuring kyphosis

KYPHOSCOLIOSIS

KYPHOSIS
Kyphoscoliosis. Coloured frontal X-ray image of the spine of a 30year-old patient with kyphoscoliosis. This spine deformity consists of both lateral (side-to-side) curves (scoliosis) and dorsal (front-toback) curves (kyphosis). Scoliosis often starts in infancy or adolescence and is more common in girls. The exact cause is unknown, but some cases are birth defects and others have been linked to polio or an injury. Kyphosis usually results in a humped or bowed upper back and can cause the vertebrae (back bones) to eventually collapse. It can be caused by a birth defect or through bad posture. Severe cases of kyphoscoliosis usually have an operation to correct it, where a metal support is inserted to keep the spine in a straight line.

GOUT
Gout (also known as podagra when it involves the big toe)[1] is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritisa red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected (approximately 50% of cases). However, it may also present as tophi, kidney stones, or urate nephropathy. It is caused by elevated levels of uric acid in the blood. The uric acid crystallizes, and the crystals deposit in joints, tendons, and surrounding tissues.

GOUT
Clinical diagnosis maybe confirmed by seeing the characteristic crystals in joint fluid. Treatment with nonsteroidal antiinflammatory drugs (NSAIDs),steroids, or colchicine improves symptoms. Once the acute attack subsides, levels of uric acid are usually lowered via lifestyle changes, and in those with frequent attacks, allopurinol or probenecid provide long-term prevention. Gout has increased in frequency in recent decades, affecting about 12% of the Western population at some point in their lives. The increase is believed due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy and changes in diet. Gout was historically known as "the disease of kings" or "rich man's disease".

GOUT
What is PODAGRA Gouty involvement of the great toe at the metatarsophalengeal joint. The great toe is the most common site of involvement of gout in skeleton. Differentiate primary gout from secondary causes of gout Primary gout is idiopathic and is due to an inborn error of metabolism that results in hyperuricemia. Secondary gout results from diseases that causes increased production or decrease excretion of uric acid, such as myeloproliferative disorders, chemotheraphy or radiation theraphy, multiple myeloma and chronic renal failure.

GOUT
Gout. Coloured X-ray of the right foot of a 67-year-old patient, showing damage (centre right) caused by gout in the big toe (far right). Gout is a disorder of uric acid metabolism in which crystals deposit in the joints causing painful swelling

CONGENITAL CLUBFOOT DISEASE

A club foot, also called congenital talipes equinovarus (CTEV), is a congenital deformity involving one foot or both.[1] The affected foot looks like it has been rotated internally at the ankle. Without treatment, people with club feet often appear to walk on their ankles or on the sides of their feet. It is a relatively common birth defect, occurring in about one in every 1,000 live births. Approximately half of people with clubfoot have it affect both feet, which is called bilateral club foot. In most cases it is an isolated dysmelia (disorder of the limbs). It occurs in males twice as frequently as in females.

CONGENITAL CLUBFOOT DISEASE

TEV is classified into two groups, postural TEV and structural TEV. The deformities affecting joints of the foot occur at three joints of the foot to varying degrees. They are[ inversion at subtalar joint, adduction at talonavicular joint, and equinus and varus at ankle joint, that is, a plantar flexed position, making the foot tend towards toe walking.

Pleural Effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.

PLEURAL EFFFUSION
How many kinds of pleural effusion are there A wide variety of fluids can collect in the pleural space and produce pleural effusions: Plasma ultrafiltrate Pus Blood Chyle Urine Ascitic fluid Bile

PLEURAL EFFUSION
Can CT-scan determined the content of pleural effusion? CT may be able to suggest the composition of pleural efffusion. Blood (hemothorax) is usually high in density, while chylothorax (the accumulation of chyle in the thorax, usually as a result of disruption of the thoracic duct) may be of low density because of high lipid content of the fluid. However, if the composition of a plueral effusion must be known with certainty a thoracentesis must be performed and aspirated fluid sent for biochemical, cytologic and microbiologic test.

Pleural effusion
What can chest x-ray radiographs reveal about the bature of pleural effusion Chest radiograph gives more information about quantity of fluid in the pleural space and can help determined whether the fluid is free- flowing or loculated and wether there are associated abnormalities of the pleura, lung, mediastinum, chest wall, or abdomen that may indicate the possible source of the effusion How much fluid must be present in the pleural space before an effusion can be seen on a standard erect frontal chest radiograph About 150 to 300ml

Pleural effusion x-ray

Pleural effusion. Coloured frontal Xray of the lungs of a 60-year-old patient with a pleural effusion of the left lung (right). The lungs are the red spaces either side of the chest. The left lung is smaller than the right lung due to a pleural effusion, an accumulation of fluid (lower right) in the chest cavity. The liquid compresses the lung, which leads to breathing difficulties. An effusion is treated by aspiring (draining) the fluid, which relieves the pressure.

CYSTOLITHIASIS
A bladder stone (also called a vesical calculus or cystolith) is a stone found in the urinary bladder. The term cystolithiasis refers to the presence of stones in the bladder

CYSTOLITHIASIS
Bladder stones are small particles that can form in the bladder. In most cases bladder stones develop when the urine becomes very concentrated or when one is dehydrated. This allows for the minerals like calcium or magnesium to crystallize and form stones. Bladder stones vary in number size and consistency. In some cases bladder stones do not cause any symptoms of signs and are discovered as an incidental finding on a plain radiograph However, when symptoms do occur these may include severe lower abdominal and back pain, difficult urination, frequent urination at night, fever, painful urination and blood in the urine. The majority of individuals who are symptomatic will complain of pain which comes in waves. The pain may also be associated with nausea, vomiting and chills

CYSTOLITHIASIS
Bladder stones may occur whenever the kidneys, bladder, or ureters become inflamed. The use of urinary catheters may cause a bladder stone. Individuals who are paralyzed or are unable to adequately pass urine may require the use of small plastic tubes (catheters) placed into the bladder

CYSTOLITHIASIS
The diagnosis of bladder stone includes urinalysis, ultrasonography, x rays or cystoscopy (inserting a small thin camera into the urethra and viewing the bladder). The intravenous pyelogram can also be used to assess the presence of kidney stones. This test involves injecting a radiocontrast agent which is passed into the urinary system. X-ray images are then obtained every few minutes to determine if there is any obstruction to the contrast as it is excreted into the bladder. Today, intravenous pyelogram has been replaced at many health centers by CT scans. CT scans are more sensitive and can identify very small stones not seen by other tests

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

ARIEL BARROS RRT,

ARIEL BARROS RRT,