The radio diagnostics of inflammatory diseases of the musculoskeletal system

Section contents:

Radiological signs of inflammatory damages of the musculoskeletal system: tuberculosis of bones and joints, osteomielitis, reumatoid arthritis, syphilitic defeat of bones.

The inflammatory diseases of the bones: tuberculosis of bones (tubercular osteitis) and joints (primary-osteal and primary-synovial form)

The tubercular osteitis

Radiological features: focuses of destruction (size 1.2-2.5 sm) located in epymetaphysis with irregular margins, the spongy sequestrum in a center of destruction maybe are located (as "piece of melting sugar"), osteoporosis (local, regionar), periostitis is absence, in child's age atrophy of bone is potential.

The joint tuberculosis accounts for 20% of all tubercular damages of bones.

The primary bone form runs in three phases(see fig12.1) : 1) a prearthritical phase corresponds to tubercular ostitis; 2) arthritical phase - a process passes from bone tissue to soft tissue and cartilaginous elements of joint, spreads quickly, causes the acute exudative reaction and excrescence of granulation tissue, destruction of joint cartilages and joint surfaces of epiphysises. After some expansion there is narrowing of roentgenologic joint space and regionarniy osteoporosis, a destructive process causes considerable deformations of joint surfaces of bone, resulting in their congruent lost, and in more widespread destructions come destructive dislocations; 3)postarthritical phase is completed by fibrotic ankylosis.

1 2 3

Fig.12.1 1 - tubercular ostitis; 2 – arthritical phase; 3 - posatarthritical phase (fibrotic ankylosis)

The roentgenologic picture of the primary synovial form (see fig 12.2) in early stages corresponds to the picture of hydropsy of joint (expansion of joint space, regionary osteoporosis of bones, that form a joint, and thickening of joint capsule). Afterwards in 1-2 months in the places of attachment of capsule the small regional defects of irregular, rounded or oval form become noticeable. A thin cortical layer disappears and trabecules of the spongy substance resolve partly or fully. Destruction of cartilages is represented on pictures by narrowing of x-ray joint space. The stages of development of bone tuberculosis accoding to CORNEV P. G.: 1^st- beginning, 2^nd- height, 3rd- subsiding of process.

1 2

Fig.12.2 the primary-synovial form of joints tuberculosis: 1 – hydropsy of joints; 2 – destruction of joint cartilages and joint ends of bones.

The roentgenologic signs of tubercular spondilitis:

1) the decline of height of the inter-vertebral disk

2) the decline of height of the vertebral body (sign of pathological compression)

3) the destruction of the vertebral body in the type of separate focus, more frequent in the type of defect of edge in combination with destruction of the disk

4) the deformation of column with formation of a hump – angular kyphosis

5) the shades of abscess are observed in 80-90% cases in the defeat of thoracic department of column.

1 2 3

Fig.12.3. Lumbar department of column: 1 – norm; 2, 3 – tubercular spondilitis.

The tubercular coxitis (see fig 12.4). It the primary-bone disease usually - a primary tubercular focus arises up more frequent (64%) in bones of acetabulum. As a result of fracture of process in a joint there is destruction of joint cartilages, synovial sitll, joint bag, afterwards a process passes to other bone. Possible dystensional luxations in acute processes, as a result of distension of the joint bag by a plenty of exudate, at considerable destructions of bones`s joint ends there are destructive dislocations. In favourable course and timely medical treatment the process can end by some deformation of joint surfaces with saving of joint function; in the expressed destructions of joint surfaces a process ends with intracoxigeal pseudoartrosis or fibrotic ankylosis or destructive dislocation. X-ray signs: regionarniy osteoporosis, compression of joint bag, focus of destruction in bones of a joint.

Fig.12.4. Tubercular coxitis

The Spina ventosa tuberculosa is the tuberculosis of diaphysis of tubular bones. The roentgenologic signs are deformation (thickening), destruction, sequestrum as a “piece of melting sugar”, periosteitis. The completions are disappearance of destruction and periosteitis.

Osteomyelitis (see fig 12.5) is the festering disease of bones, usually of staphylococcal etiology. We distinguish acute itmatogenic, gunshot, primary-chronic and secondary-chronic osteomielitis. Frequency of defeat: Thighbone - 46%, a shinbone is a 42% humeral bone - 10%, other bones - 3%.

The ordinary form of osteomielitis runs across in 4 phases: 1^st- the phase of acute bone brain inflammation is a phlegmon, 2^nd- fracture of process under the periosteum and formation of abscess; 3rd- necrosis of bone; 4^th- phase of sequestration and reparation. X-ray signs appear on the 12-16 day of the disease: the focus of destruction in metadiaphysis is surrounded by osteosclerosis, in a center the sequestrum (corticalniy, central, penetrable, total), along a bone linear, fimbriated periosteitis. Gunshot osteomielitis is a result of development of festering infection in the gunshot fracture.

1 2 3

Fig.12.5 1 – types of sequestrum; 2 – acute osteomielitis; 3 – chronic osteomielitis; 4 –gunshot osteomielitis

The second-chronic osteomielitis is the result of acute hematogenic osteomielitis, is characterized by expressed bone-formation as the spacious areas of osteosclerosis, surrounded by the areas of liquid or normal bone tissue, sequestrum located in cavities with sclerostic contours, periostitis (fimbriated, crista-like, striped).

The atypical forms. Epiphysar osteomielitis meets in 72% cases under age of 2 years and is caused by strepto-, staphylo - and pneumococci. A process is more frequent by is localized in epiphysis thighs, runs acutely. Epiphysis collapses fully; there is suppuration of joint, rupture of abscess with formation of fistula. On a sciagram a thigh-bone is deformed, epiphysis and the part of metaphysis are absent; trochanter cavity of the bone is smoothed, femoral bone is in a state of dislocation up and is joined with an illum. The trochanter cavity in a process is not pulled in.

The chronic Garre’s primary-sclerotic osteomielitis (see fig 12.6): beginning is primary-chronic, the edema in connective tissues (infiltration of muscles) appears, limitation of mobility in surrounding joints. Roentgenologically: osteosclerosis, eburneation of (destructive foci, cavities, sequestrum are not present) and hyperostosis.