(dn)musculoskeletal - dr.sri andreani sprad(k) 280310 (1).pdf

7/26/2019 (DN)Musculoskeletal - dr.Sri Andreani SpRad(K) 280310 (1).pdf

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FORMAL EDUCATION BACKGROUND :

Sri Andreani Utomo

•Graduated from Faculty of Medicine, Airlangga University : 1984

•Obtained the specialist degree for Radiology, January 1997

•Obtained The Master Degree In Neurovascular Diseases, Paris Sud University and

a o n vers ty, e on a an , ovem er - ovem er .

PRESENT POSITION and MEMBERSHIP•. Neuroradiology Consultant

. , . , ,

Airlangga University, Surabaya, Indonesia.

•Foreign Relationship in Indonesian Radiological Society.•

Radiology.

•Member of The Asian-Oceanian Society in Neuroradiology and Head & Neck

Radiology

•Member of The Asian Musculoskeletal Society.•Member of Neuroradiology Team , Dr. Soetomo Hospital, Surabaya, Indonesia.

•Member of The Spinal Team(Pan Med Tulang Belakang) Dr. Soetomo Hospital,

Surabaya, Indonesia.

•Member of The Oncology Musculoskeletal Team (Pertumsi), Dr. Soetomo Hospital,Surabaya, Indonesia.



Sri Andreani Utomo



Tumor

Congenital Anomali Degenerative



Plain Radography.

CT Scan. MRI.



radiography

caused by a skeletal deformity or.

May reveal soft tissue calcification

a can sugges a spec c agnos s



Plain Radio ra h

characteristic of a specificdiagnosis:

* Phleboliths within a

haeman ioma.

* Synovial

osteochondromatosis.

* Myositis ossificans.



CT might hold a minor advantage

over MRI in diagnosis of soft tissue

.

CT has been replaced by MRI



Pre op



Post op



Mr.Os. 23 yo with large tumor at dorsal right upper leg since 6 yrs. ago.

MRI: mass located intramuscular. X-ray: no bone lesion.

Pre o



PA:

Soft tissue tumor 18 X 16 X 10 cm

Solid lobulated with

,

Hemorrhage & cystic

Degeneration------ MalHemangiopericytoma



“Triple

D agnos s

FindingsFindings

PatholoPatholo

23



AGRESIFITAS DARI LESI TULANG

24



NON AGRESIF JINAK

25



Jinak vs Ganasa s Ga as

..

..

periostealperiosteal

3.3.BesarnyaBesarnya

massamassa

ar nganar nganlunaklunak

26



Jenis Destruksi

(3 jenis)

Benign/Mali nant

27



28



BATAS lesi

Destruksitulang

29



Margins

geographic ill defined moth-eaten permeative

less aggressive more aggressive



Matrix



non a ressive

none smooth

aggressive lamellated (onion skinning)

sunburst / hair on end

o man s r ang e



DIAGNOSIS PATOLOGI, harus melalui

serangkaian analisis yang melibatkan:

Agresifitas Agresifitas++

mur mur

33



July 13, 2006



Nov 15, 2006

Oct 17, 2006



Jan 7, 2007



Cuts section: widely necrotic areas admixed with adipose tissue and fragments of small bones.



Bone fragment, calcified nodule, epitheloid cells and caseos necrosis.



Multiple small hard tubercles containing Langhans giant cells.

Case 2



Case 2

57 y.o / Female

C.C : Lump at the right shoulder

Gradually increased pain and decreased ROM

Onset : 1 year ago No history of trauma

Lab data noncontributory



Post op



Post op.



Villonodular Synovitisillonodular Synovitis

Uncommon benign proliferative disorder of thesynov um w un nown cause

Mainly 2nd – 4th decade ( range 12 – 68 years)

Usually painless or only mildly painful

,Location : knee, ankle, hip, elbow, shoulder, tarsal

+ car al oint redominantl monoarticular side

Its diagnosis is often delayed because complaintand symptoms are non-spesific



Destructive changes of the joint

Multiple lytic lesions

Joint narrowing

Soft tissue swelling around the joint



Masses of synovial tissue as synovial proliferation

Joint capsular extension with effusion

es ruc on o e ar cu ar sur ace o ones

Predominantly low signal intensity on all

sequences



Villonodular appearance of synovial

Hyperplasia of undifferentiated connective

and mononuclear cells



Synovial osteochondromatosis

Synovial sarcoma



T1FSE T2FRFSE T2GE



Spina bifida apertaSpina bifida occulta

S ina Bifida A erta



Myelocele

Myelomeningocystocele

Spina Bifida Occulta



Meningocele

Spinal Lipoma

Li om elomenin ocele

Fibrolipomatosis of the filum

terminale Tethered cord

Dorsal dermal sinus

Non D sra hic S inal Malformation



Congenital tumorsSpinal cysts

Syringomyelia

ongen ta stenos s o t e sp nacanal.



Failure of Se mentationFailure of Formation

Failure of formation

Imaging Modalities

Myelography: The presence of congenital



Myelography: The presence of congenital

myelogram.

bone

w e u wimaging for vertebral body abnormalities.

: as ecome a very use u mo a y

imaging for evaluating the presence or absence.



M, 11 yo with torticolis

MRI



40 yo M with block vertebrae and central canal stenosis



Fracture dislocation



Unfused vertebrae



Non D sra hic S inal Malformations



au a regress on



T1 T2 T2 Fat Sat



MRI T2 CT Axial



Right hip Left hip



6

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