




版權(quán)說明:本文檔由用戶提供并上傳,收益歸屬內(nèi)容提供方,若內(nèi)容存在侵權(quán),請進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡介
1、1,.,By Bone Group 2013-10-24,CASE DISCUSSION,2,.,History,Male,29Y Complaint:bilateral knee pain with intermittent fever for 4 years,3,.,4,.,5,.,6,.,7,.,8,.,Key signs? Your impression? DDX?,9,.,Laboratory examination Uric Acid(UA):478.3mol/L Treatment Allopurinol(ALLO),10,.,Final diagnosis,Gouty Arth
2、ritis,11,.,Background,Gout is a form of inflammatory arthritis that is characterized initially by acute attacks of active synovitis related to the presence of monosodium urate (MSU) crystals in the joints and periarticular soft tissues. Accounting for 3-7 in panarthritis Men40 years old Genetic pred
3、isposition,12,.,Background,Most classically in the first metatarsophalangeal joint (toe) A history of underlying renal disease or use of medications that cause hyperuricemia Gold standard : monosodium urate (MSU) crystals in the joint fluid or tophus,13,.,Pathogenesis,MSU crystals Lipids Protein Muc
4、opolysaccharides The tophus eroding the underlying bone is pivotal in the development of bone erosions in gouty arthritis. MSU crystal deposition is associated with the presence of underlying OA.,14,.,Radiologic hallmarks,Presence of macroscopic tophi Normal mineralization Relative joint space prese
5、rvation Erosions with overhanging edges A gradually expanding tophus eroding at the bone cortex with concomitant new periosteal bone formation trying to contain the tophus Asymmetric polyarticular distribution,15,.,X-RAY,Chronicity of the disease process Only 45,only 6-8 years “Punched out” Until 61
6、2 years after the initial acute attack,16,.,17,.,18,.,CT,82% visible tophi Large erosions 7.5 mm diameter,19,.,20,.,21,.,MRITophi,T1WI Homogeneous and generally isointense to muscle T2WI Varied Intermediate to low heterogeneous signal intensity A variable enhancement Peripheral enhancement pattern,2
7、2,.,23,.,24,.,25,.,DDX,Chondrocalcinosis (pseudogout) Rheumatoid arthritis (RA) Pigmented villonodular synovitis(PVNS),26,.,Chondrocalcinosis,Commonly found in the elderly Mostly occuring in the knee joint Deposition of different types of crystals in the hyaline articular cartilage and/or fibrous ca
8、rtilage of the menisci Predominant:Calcium pyrophosphate dihydrate (CPPD) Produce severe degenerative joint disease (pyrophosphate arthropathy),27,.,Radiographic hallmarks,Articular and periarticular calcification Only involving 1 or 2 joints Discrete areas of low signal intensity within the articul
9、ar cartilage More apparent on GRE sequences Joint space narrowing Subchondral osteosclerosis Articular surface subsidence,28,.,29,.,30,.,RA,Characterized by an inflammatory synovitis and a potential to destroy bone and cartilage Mostly seen in middle-aged woman Symmetric distribution RF(+),31,.,Radi
10、ologic hallmarks,Extensive and diffuse synovial hyperplasia and inflammation Synovial pannus formation Marked enhancement Serious articular cartilage degeneration(Grade or ) Local marginal erosions Obvious local osteoporosis Joint space narrowing in early stage,even fusion,32,.,33,.,34,.,35,.,PVNS,C
11、haracterized by synovial proliferation and hemosiderin deposition into the synovial tissues of the affected joint Men aged 20-40 years old Mostly seen in knee and ankle joint Proliferation(villous/nodular/mixed) Nodular variety commonly seen in the tendon sheaths, principally on the volar aspect of
12、the phalanges,36,.,Radiologic hallmarks,Variable extent of synovial proliferation Joint effusion and erosion of bone Deposit of hemosiderin within the synovial masses Low signal on both T1WI and T2WI Best seen on FFE sequence,37,.,38,.,39,.,Treatment,Colchicine Not an accurate tool to diagnose gout(
13、psoriatic arthritis&pseudogout) Cold applications A useful adjuvant treatment(RA),40,.,Conclusion,Plain radiographs are less sensitive to early changes in chronic gout than other imaging techniques. CT may be the most specific imaging technique when evaluating intraosseous lesions, while MRI could be the preferred technique to evaluate chronic synovial involvement. The presence of structural changes in radiographs correlates with poor function, and is associated with irreversibility of changes.,41,.,42,.,后面內(nèi)容直接刪除就行 資料可以編輯修改使用 資料可以編輯修改使用,43,.,主要經(jīng)營:網(wǎng)絡(luò)軟件設(shè)計(jì)、圖文設(shè)計(jì)制作、發(fā)布廣告等 公司秉著以優(yōu)質(zhì)的服務(wù)對待每一位
溫馨提示
- 1. 本站所有資源如無特殊說明,都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等,如果需要附件,請聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙,網(wǎng)頁內(nèi)容里面會(huì)有圖紙預(yù)覽,若沒有圖紙預(yù)覽就沒有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 人人文庫網(wǎng)僅提供信息存儲(chǔ)空間,僅對用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理,對用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯,并不能對任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容,請與我們聯(lián)系,我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對自己和他人造成任何形式的傷害或損失。
最新文檔
- 古琴文化與演奏藝術(shù)教程書
- 小學(xué)三年級下冊數(shù)學(xué)鞏固練習(xí)計(jì)劃
- 2025至2030中國自動(dòng)滴漏式咖啡壺行業(yè)發(fā)展趨勢分析與未來投資戰(zhàn)略咨詢研究報(bào)告
- 2025至2030中國腹水治療行業(yè)產(chǎn)業(yè)運(yùn)行態(tài)勢及投資規(guī)劃深度研究報(bào)告
- 2025至2030中國脫氫乙酸(DHS)行業(yè)產(chǎn)業(yè)運(yùn)行態(tài)勢及投資規(guī)劃深度研究報(bào)告
- 2025至2030中國脂肪填充奶粉(FFMP)行業(yè)市場深度研究及發(fā)展前景投資可行性分析報(bào)告
- 2025至2030中國膠囊內(nèi)窺鏡和工作站行業(yè)產(chǎn)業(yè)運(yùn)行態(tài)勢及投資規(guī)劃深度研究報(bào)告
- 2025至2030中國胃食管反流病藥物及器械行業(yè)市場占有率及投資前景評估規(guī)劃報(bào)告
- 2025至2030中國肥料噴射器行業(yè)產(chǎn)業(yè)運(yùn)行態(tài)勢及投資規(guī)劃深度研究報(bào)告
- 2025至2030中國聚光類球面透鏡行業(yè)發(fā)展研究與產(chǎn)業(yè)戰(zhàn)略規(guī)劃分析評估報(bào)告
- 朝花夕拾考試題及答案
- 高中堅(jiān)持議論文范文7篇
- (外研版3起)英語五年級上冊單詞字帖書寫練習(xí)(手寫體)高清打印版
- 一例急性心肌梗死合并糖尿病酮癥酸中毒患者的個(gè)案護(hù)理
- 胰島素注射篇課件
- 教師的職業(yè)生涯規(guī)劃與專業(yè)發(fā)展課件
- 生物安全自查表
- 廣州小升初-學(xué)籍表打印版
- 天津市-解除勞動(dòng)合同證明書
- 公司一年完稅證明模板
- DB5306∕T 69-2021 果樹主要實(shí)蠅害蟲綜合防控技術(shù)規(guī)程
評論
0/150
提交評論