Principles Of Bone X-Ray DiangosisPDF电子书下载

1 ALTERATIONS IN BONE SHAPE 1

Generalized alterations in shape 1

Achondroplasia 1

Osteogenesis imperfecta (fragilitas ossium) 2

Chondro-osteodystrophy 3

Acromegaly 4

Muscular paralysis 5

Regional alterations in shape 5

Congenital growth defects 6

Craniocleidodysostosis 6

Arachnodactyly 6

Club foot 6

Gross failure in the development of the hands or feet 6

Congenital wedge-shaped and supernumerary vertebra 6

Spina bifida 6

Fusion of vertebral bodies 8

Regional deformities due to disease 6

Deformity of vertebral bodies 8

Faulty modelling of the long bones 9

Deformity following epiphyseal damage 9

Local bony protuberance 9

Exostosis 9

External chondroma 12

Local bone deficiency 12

Collapse of a single vertebra 13

Spinal osteoporosis with collapse of a single vertebra 13

Vertebral osteochondritis 13

Xanthomatous deposit 14

Traumatic and post-traumatic collapse 14

Hydatid cyst 14

Neoplastic secondary deposit 15

Secondary deposit with disc intrusion 15

Benign tumour 15

Paget＇s disease 15

Developmental defect 16

Tuberculous lession with vertebral collapse 16

Deformity from softening of the bones 17

The pelvis 17

The long bones 18

2 ALTERATIONS IN THE POSITION OF A BONE 19

Congenital elevation of the scapulae 19

Depressed sternum 19

Genu valgus 19

Spondylolisthesis 20

Congenital dislocation of the hip 22

Displaced patella 24

Congenital dislocation of the talus 24

Scoliosis 24

3 ABNORMALITIES IN THE REGION OF THE EPIPHYSES 26

Alteration in the maturity of the epiphyses 26

Acceleration of epiphyseal maturity 26

Retardation of epiphyseal maturity 27

Acceleration or retardation of epiphyseal fusion 28

Generalized alteration in the appearance of the epiphyses 28

Developmental defects 29

Chondro-osteodystrophy 29

Gargoylism 30

Dyschondroplasia or chondrodystrophy 30

Multiple epiphyseal dysplasia (chondrodysplasia) 31

Endocrine epiphyseal defects 32

Hypothyroidism (cretinism) 32

Dietetic epiphyseal disorders 32

Rickets 32

Scurvy 34

Heavy metal deposition in the metahyseal region 35

Abnormality of a single epiphyseal region 36

Osteochondritis of the femoral head (Perthes＇ disease) 36

Slipped upper femoral epiphysis (adolescent coxa vara) 37

Osteochondritis of the tibial tuberosity (Osgood-Schlatter＇s disease) 38

Osteochondritis of a metatarsal epiphysis 39

Osteochondritis of the navicular (Kohler＇s disease) 39

Osteochondritis of the primary centre of a vertebral body (Calvé) 39

Osteochondritis of the secondary centre of a vertebral body (Scheuermann＇s disease) 40

Uncommon sites of epiphyseal fragmentation (osteochondritis，epiphysitis) 40

4 INCREASES IN BONE DENSITY 42

Generalized increase in bone density 42

Developmental osteopetrosis 42

Developmental osteopoikilosis 44

Secondary deposits 44

Myelosclerosis 46

Renal osteosclerosis 46

Hypervitaminosis 48

Fluorosis 48

Paget＇s disease 48

Increase in density of a single vertebra 48

Secondary deposit of carcinoma 48

Hodgkin＇s disease 48

Paget＇s disease 49

Local vascular disorder 49

Low-grade chronic osteomyelitis 50

Benign tumour or developmental defect 50

Primary bone sarcoma 50

Isolated increase in bone density in a limb bone，rib or pelvis 50

Developmental defect 50

Deep bone infarct 50

Healing cyst 52

Avascular necrosis or osteochondritis 52

Dense lunate 52

Dense talus or scaphoid 52

Dense patella 52

Dense femoral head 53

dense terminal phalanx 53

Secondary deposit 53

Sclerosing osteitis and sarcoma 53

Condensans ilii 54

Isolated increase in density in the skull or facial bones 54

Anatomical variations 54

Hyperostosis frontalis 55

Meningioma 56

Inflammatory lesion 56

Secondary deposit 56

Leontiasis ossea 56

Paget＇s disease 56

5 NEW BONE AND CALCIFICATION OUTSIDE THE CORTEX (PERIOSTEAL SHADOW OR PERIOSTITIS) 57

Post-traumatic periosteal shadow 58

Non-traumatic haematoma 58

Stress fracture and fatigue fracture 59

Inflammatory conditions 61

Pyogenic or typhoid bone infections 61

Syphilitic bone lesions 61

Tuberculous bone lesions 61

Fungus infections of bone 62

Benign neoplasm 62

Osteoid osteoma 62

Malignant neoplasm 62

Vascular disorders 63

Varicose veins and arterial occlusion 63

Pulmonary osteoarthropathy 63

Idiopathic hypertrophic osteoarthropathy 64

Melorheostosis (Leri) 64

Diaphyseal dysplasia (Engelmann) 64

6 WIDESPREAD AND REGIONAL DECREASES IN BONE DENSITY 65

Introduction 65

Widespread even decalcification 66

Endocrine disorders 66

Cushing＇s syndrome 66

Cortisone therapy 67

Late stage acromegaly 68

Hyperthyroidism 68

Ovarian agenesia and eunuchoidism 68

Old age 68

Dietetic deficiencies 68

Calcium and phosphorus 68

Vitamin D 68

Vitamin C 69

Protein 69

Alimentary tract disorders 69

Osteomalacia from deficient fat and vitamin D assimilation 69

Looser zone or Milkman fracture in osteomalacia 69

Metabolic disorders－renal osteodystrophy 70

Haemopoietic diseases 71

Leukaemia in children 71

Leukaemia in adults 73

Histiocytosis (Gaucher＇s disease) 73

Myelomatosis 73

Coarsened trabecular pattern associated with decalcification 73

Hyperparathyroidism 73

Hypoparathyroidism 75

Sickle-cell (Cooley＇s) anaemia 75

Alimentary tract disorders 75

Patchy decalcification 77

Secondary neoplasm and myelomatosis 77

Old age 78

Haemopoietic diseases 79

Decreased bone density in one region or group of bones 79

Spinal decalcification 79

Disuse and sepsis decalcification of part of a limb 81

7 A TRANSLUCENT AREA IN A BONE 83

Introduction 83

Well-demarcated translucent area within a bone 83

Simple cysts of uncertain aetiology 83

Osteitis fibrosa cystica (in hyperparathyroidism) 85

Developmental defects 86

Fibrous dysplasia 87

Non-osteogenic fibroma (fibrous metaphyseal defect) 88

Chondromyxoid fibroma 89

Chondroblastoma 89

Aneurysmal bone cyst 89

Tuberose sclerosis (Mesodermal dysplasia) 89

Arterio-venous aneurysm 90

Haemangioma 90

Chondroma or hamartoma 90

Neurofibromatosis 92

Tumours 92

Osteoclastoma 92

Solitary plasmacytoma 92

Secondary deposit 92

Granulomas 94

Xanthomatous granuloma 94

Non-specific granuloma 95

Histiocytosis (Gaucher＇s disease) 95

Sarcoid 95

Infective conditions 96

Tuberculosis 96

Pyogenic infection 97

Fungoid infection 97

Yaws 97

Hydatid cysts 97

Post-traumatic cyst-like translucency 97

Haemophilia with haemorrhagic bone cyst 97

Cyst-like translucency in association with arthritis 97

Well-demarcated translucent area with cortical thinning and gross bone expansion 98

Simple cyst of uncertain origin 98

Hyperparathyroidism (osteitis fibrosa cystica) 99

Developmental defects 100

Monostotic fibrous dysplasia 100

Giant-cell tumour variants 100

Chondroma 100

Neoplasm 101

Osteoclastoma 101

Solitary plasmacytoma 102

Secondary deposit 102

Infection 102

Well-demarcated erosion of the surface of a bone 104

Pressure erosion 104

Pressure from occupation 104

Pressure from an aneurysm 104

Pressure from a neurilemmoma，ganglioneuroma or dilated intercostal arteries 105

Intervertebral disc intrusion (schmorl node) 105

Developmental defect and implantation dermoid 105

Urate deposit 105

Surface absorption of the tip of a terminal phalanx 105

Pyogenic infection 105

Leprosy 105

Trauma 106

Vascular disorders 106

Neuropathic disorders 107

Developmental defect 107

Articular cortex surface erosion－osteochondritis dissecans 108

Poorly-demarcated translucent area within the bone 108

Malignant neoplasm－primary bone or secondary deposit 109

Fibrous dysplasia 110

Haemangioma 110

Xanthomatous granuloma 110

Tuberculous lesion 111

Poorly-demarcated erosion of the surface of a bone 111

Malignant neoplasm 111

Xanthomatous granuloma 112

Tuberculosis 113

A translucent area in the vault of the skull 113

Anatomical variations 113

Depression for a Pacchionian body 113

Emissary veins 114

Diploic venous pool 114

Congenital parietal foramen 114

Developmental defects 114

Meningocoele 114

Fibrous dysplasia 114

Haemangioma 114

Intradiploic dermoid and epidermoid 114

Extracranial dermoid 114

Acquired lesions 115

Post traumatic cyst-like area 115

Post radiation necrosis 115

Hyperparathyroidism 115

Xanthomatosis granuloma 115

Infective conditions 115

Direct trauma 115

Secondary deposit 115

Response to an intracranial lesion 116

Meningioma 116

Direct invasion from scalp neoplasm 116

Rodent ulcer 116

Carcinoma 116

8 COMBINATION OF SHADOWS 117

Periosteal opacity and erosion 117

Pyogenic inflammation 117

Tuberculous inflammation 121

Syphilis 121

Fungus infection 123

Actinomycosis 123

Madura foot 124

Blastomycosis 124

Coccidioidomycosis 124

Cysts and inocent tumours 124

Malignant neoplasm 124

Malignant bone tumours with much erosion 124

Malignant bone tumours with much calcification 127

Malignant bone tumours with much periosteal new bone 128

Differential diagnosis 129

Periosteal shadow and sclerosis 130

Low-grade chronic osteomyelitis 131

Diaphyseal dysplasia (Engelmann) 131

Osteoid osteoma 132

Syphilis 132

Malignant neoplasm 132

Periosteal opacity with erosion and sclerosis 132

Chronic osteomyelitis 132

Sequestra in osteomyelitis 132

Chronic localized bone abscess 133

Osteoid oesteoma 133

Malignant neoplasm 134

9 ALTERATIONS IN THE BONE ARCHITECTURE 135

Paget＇s disease 135

Paget＇s disease and sarcoma of bone 137

10 ALTERATIONS IN JOINT SPACE (ARTHRITIS) AND ASSOCIATED BONE CHANGES 139

Introduction 139

The diminished joint space 139

Associated bone changes 139

Difficulties of classification 139

Arthritis of known cause 140

Pyogenic arthritis (septic arthritis) 140

Gonococcal arthritis 141

Virus arthritis 141

Tuberculous arthritis 141

Haemophilia with arthritis (haemorrhage into a joint) 145

Arthritis of unknown cause 145

Classical rheumatoid arthritis 145

Unusual manifestations of rheumatoid arthritis 148

Unusual distribution of affected joints 148

Unusual age of onset 149

Milder type of lesion 149

Unusual radiographic appearances 150

Arthritis in association with other diseases 150

Arthritis with psoriasis 151

Arthritis with ulcerative colitis 151

Arthritis with non-specific urethritis 152

Arthritis with rheumatic fever 152

Arthritis with systemic lupus erythematosus 152

Ankylosing spondylitis 152

Arthritis of partly-known origin 154

Degenerative or osteoarthritis 154

Intra-articular loose bodies 156

Neuropathic arthritis 157

Metabolic defect with arthritis 157

11 SOME HINTS ON χ-RAY TECHNIQUE 159

Plain radiographs 159

To acquire good detail 159

To acquire good contrast 159

Measurement of bone length 159

Tomography 160

Selection and spacing of layers 160

Simultaneous multisection tomography 160

Value oftomography 161

Injection of simuses 163

Avoidance of excessive radiation 163

12 BONE IN UNUSUALSITES AND CALCIFICATIONS IN OR NEAR A JOINT 164

Bone in muscle and tendons 164

Ossification in a tendon 164

Myositis ossificans 164

Calcifications in structures or near a joint 164

Calcification in a joint cartilage 164

Calcification in a joint capsule 165

Calcification in a joint ligament 165

Calcification in the supraspinatus tendon 165

Calification near the finger joints 166

Calcification in tuberculous synovitis 166

Calcification in a bursa over a joint or a synovial cyst 166

APPENDIX 167

REFERENCES 170

INDEX 171