imaging techniques and fundamental observations for the musculoskeletal system dr. muhammad bin...
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45Imaging Techniques and
Fundamental Observations forthe Musculoskeletal System
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• FIGURE 45-1 (A) AP ■radiograph of index finger demonstrates
dislocation of the proximal interphalangeal joint (arrow). (B) Dislocated distal interphalangeal joint is only evident on the
orthogonal view (arrow).
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FIGURE 45-2 (A) Lateral radiograph of the elbow ■shows joint effusion displacing the fat pads (*) indicating intra-articular injury. (B) Horizontal beam lateral radiograph of the knee shows lipohaemarthrosis due to occult fracture with a linear fat (white arrow)/fluid (black arrow) level.
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FIGURE 45-3 Lateral radiographs of the cervical spine ■in (A) extension and (B) flexion. Atlantoaxial subluxation due to disruption of the transverse ligament is demonstrated on the view taken in flexion with widening of the atlantoaxial distance(black arrows).
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• FIGURE 45-4 Fluoroscopic image of the ■shoulder shows contrast medium within the glenohumeral joint extending into the subacromial bursa (arrowhead) indicating a rotator cuff tear.
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• FIGURE 45-5 Tomographic image of medial ■right medial clavicle fracture (arrows), normal left side.
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FIGURE 45-6 Sonographic image of the medial thigh ■shows heterotopic calcification (*) and posterior acoustic shadowing (arrows) within the adductor musculature not evident on radiographic assessment.
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• FIGURE 45-7 Transverse PD sonogram of the ■first extensor compartment tendons (T) at the wrist. Abnormal vascularisation, particularly within the tendon sheath surrounding the tendons, indicates tenosynovitis.
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• FIGURE 45-8 Longitudinal ultrasound ■images of the long head of biceps tendon (arrows). (A) Distal anisotropic artefact. (B) Artefact eliminated using beam steer.
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• FIGURE 45-9 EFOV sonogram of the lower ■calf shows hypoechoic fascicle bundles covered by hyper echoic perimysium. Echogenic epimysium surrounds each muscle (arrows).
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• FIGURE 45-10 Partial thickness tear of the ■Achilles tendon. B-mode US shows focal hypoechogenicity (lower arrow). Elastogram shows decreased tendon stiffness (upper arrow).
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• FIGURE 45-11 99mTc-■MDP bone scintogram shows normal distribution of radiotracer within the skeleton and urinary tract. The renal outlines are visible (arrowhead) and radiotracer is evident within the urinary bladder (arrow).
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• FIGURE 45-12 SPECT CT ■of the mandible. Axial image shows increased radiotracer uptake (arrows) due to osteonecrosis of the jaw; increased uptake posteriorly is due to degeneration within the cervical spine.
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• FIGURE 45-13 (A) ■Longitudinal and (B) transverse ultrasound images of the median nerve (arrowheads) showing hypoechoic fascicles differing from the fibrillar pattern within adjacent tendons (arrows).
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• FIGURE 45-14 Coronal MR images of a ■skeletally immature patient. (A) T1-weighted and (B) proton density fat-saturated images
showing yellow marrow in the epiphyses (Y) and red marrow in the metadiaphyses (R).
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FIGURE 45-15 Axial MR ■images through the mid-thigh. (A) T1- and (B) T2-weighted fat-saturated images showing skin, normal fat distribution, muscle and bone.
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FIGURE 45-16 Pelvic radiograph of a patient ■with chronic renal failure. Extensive vascular calcification and soft-tissue calcification. External artefact from ileostomy bag (arrows), IUCD (I) and right femoral line (F).
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FIGURE 45-17 Hip radiograph shows ■phleboliths of the pelvis venous plexus. One phlebolith is en face and so has a central lucency (arrow).
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FIGURE 45-18 Hand radiograph of patient with ■Maffucci’s syndrome shows extensive multiple enchondromas with phleboliths in soft-tissue haemangiomas.
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FIGURE 45-19 Extensive heterotopic ■ossification with ankylosis (arrows) of the left hip in a patient with post-traumatic quadriplegia.
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FIGURE 45-20 AP radiograph of shoulder ■showing dense hydroxyapatite deposit (arrows) in the superior rotator cuff in a patient with calcific tendinosis.
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FIGURE 45-21 Radiograph of the forearm ■shows neural calcification (arrows) in leprosy.
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FIGURE 45-22 Rice-like calcification of ■cysticercosis (arrows) affecting the psoas muscle.
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• FIGURE 45-23 Coiled calcification within ■the subcutaneous tissues of the lower leg in guinea worm infection.
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FIGURE 45-24 Radiograph ■of the hand in a patient with progressive systemic sclerosis. Calcinosis circumscripta (arrow), soft-tissue loss of the tip of the index finger and thumb MCP joint arthritis are present.
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FIGURE 45-25 Osteosarcoma of the proximal humerus. Ra■ diograph shows dense new bone formation and aggressive periosteal reaction. Ossified lymph node metastases (arrows). (B) 99mTc-MDP bone scintigraphy shows increased radiotracer uptake within the primary humeral lesion, malignant lymph nodes within the axilla and spinal and pelvic bone metastases.
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FIGURE 45-25 Osteosarcoma ■of the proximal humerus. Radiograph shows dense new bone formation and aggressive periosteal reaction. Ossified lymph node metastases (arrows). (B) 99mTc-MDP bone scintigraphy shows increased radiotracer uptake within the primary humeral lesion, malignant lymph nodes within the axilla and spinal and pelvic bone metastases.
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FIGURE 45-26 Parasagittal MRI images of the ankle. (A) T2-■weighted fat-saturated and (B) T1-weighted images show fluid (F) and air (A) collections posteriorly tracking from a plantar ulcer (arrows). There is osteomyelitis within the calcaneus with intraosseous gas and surrounding bone oedema (O).
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FIGURE 45-26 Parasagittal MRI images of the ankle. (A) T2-■weighted fat-saturated and (B) T1-weighted images show fluid (F) and air (A) collections posteriorly tracking from a plantar ulcer (arrows). There is osteomyelitis within the calcaneus with intraosseous gas and surrounding bone oedema (O).
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FIGURE 45-27 Soft-tissue gas. (A) Radiograph of the forefoot in ■ a diabetic patient with the dappled low-density appearances of gas in the soft tissues of the second toe; note vascular calcification and osteopenia. (B) Reformatted sagittal CT image shows extensive soft tissue, joint and intraosseous low-density gas due to infection in a different patient.
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FIGURE 45-27 Soft-tissue gas. (A) Radiograph of the forefoot in ■ a diabetic patient with the dappled low-density appearances of gas in the soft tissues of the second toe; note vascular calcification and osteopenia. (B) Reformatted sagittal CT image shows extensive soft tissue, joint and intraosseous low-density gas due to infection in a different patient.
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FIGURE 45-28 Radiograph of the knee shows ■intra-articular gas (arrows) following penetrating injury.
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FIGURE 45-29 Different ■patients. (A) Radiograph shows stress fracture of the second metatarsal with periosteal reaction (arrows). (B) Axial CT of healing ulna fracture. The fracture remains ununited with florid surrounding periosteal reaction and callus
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FIGURE 45-29 Different patients. (A) Radiograph shows stress ■fracture of the second metatarsal with periosteal reaction (arrows). (B) Axial CT of healing ulna fracture. The fracture remains ununited with florid surrounding periosteal reaction and callus
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FIGURE 45-30 ■Hypertrophic osteoarthropathy in a patient with lung cancer. Periosteal reaction of the distal femur and proximal tibia (arrows). Lytic metastasis (M) within the medial tibia with cortical destruction.
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FIGURE 45-31 Osteoid ■osteoma of the tibia. Reformatted sagittal CT shows smooth fusiform periosteal reaction and lucent nidus (arrows).
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FIGURE 45-32 Aggressive ■periosteal reaction in Langerhans cell histiocytosis in a pediatric patient. Bone destruction and lamellated periosteal reaction (arrows) shown on (A) AP radiograph and (B) axial T2 MRI.
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FIGURE 45-32 Aggressive periosteal reaction in ■Langerhans cell histiocytosis in a paediatric patient. Bone destruction and lamellated periosteal reaction (arrows) shown on (A) AP radiograph and (B) axial T2 MRI.
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• FIGURE 45-33 Ewing’s sarcoma of the femur. (A) ■AP and (B) lateral radiographs show lamellated (L) and hair-on-end (H) periosteal reaction with Codman triangle formation (arrows).
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