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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.

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Sri Andreani Utomo

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Tumor 

Congenital Anomali Degenerative

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Plain Radography.

CT Scan. MRI.

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radiography

 

caused by a skeletal deformity or.

May reveal soft tissue calcification

a can sugges a spec c agnos s

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Plain Radio ra h

 

characteristic of a specificdiagnosis:

* Phleboliths within a

haeman ioma.

* Synovial

osteochondromatosis.

* Myositis ossificans.

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CT might hold a minor advantage

over MRI in diagnosis of soft tissue

.

CT has been replaced by MRI

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Pre op

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Post op

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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

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PA:

Soft tissue tumor 18 X 16 X 10 cm

Solid lobulated with

  ,

Hemorrhage & cystic

Degeneration------ MalHemangiopericytoma

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 “Triple

D agnos s

 

FindingsFindings

PatholoPatholo

23

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  AGRESIFITAS DARI LESI TULANG

24

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NON AGRESIF JINAK

25

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Jinak vs Ganasa s Ga as

..

..

periostealperiosteal

3.3.BesarnyaBesarnya

massamassa

ar nganar nganlunaklunak

26

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Jenis Destruksi

(3 jenis)

Benign/Mali nant

27

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28

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BATAS lesi 

Destruksitulang 

29

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Margins

geographic ill defined moth-eaten permeative

less aggressive more aggressive

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Matrix

 

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non a ressive

none smooth

aggressive lamellated (onion skinning)

sunburst / hair on end

o man s r ang e

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DIAGNOSIS PATOLOGI, harus melalui

serangkaian analisis yang melibatkan:

 Agresifitas Agresifitas++

mur mur 

33

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July 13, 2006

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 Nov 15, 2006

Oct 17, 2006

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Jan 7, 2007

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

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

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Multiple small hard tubercles containing Langhans giant cells.

Case 2

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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

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Post op

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Post op.

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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

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Destructive changes of the joint 

Multiple lytic lesions

Joint narrowing

Soft tissue swelling around the joint

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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

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Villonodular appearance of synovial

Hyperplasia of undifferentiated connective

and mononuclear cells

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Synovial osteochondromatosis 

Synovial sarcoma

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T1FSE   T2FRFSE   T2GE

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Spina bifida apertaSpina bifida occulta

S ina Bifida A erta

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Myelocele

Myelomeningocystocele

Spina Bifida Occulta

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Meningocele

Spinal Lipoma

Li om elomenin ocele

Fibrolipomatosis of the filum

terminale Tethered cord

Dorsal dermal sinus

Non D sra hic S inal Malformation

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Congenital tumorsSpinal cysts

 Syringomyelia

ongen ta stenos s o t e sp nacanal.

 

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Failure of Se mentationFailure of Formation

Failure of formation 

Imaging Modalities

Myelography: The presence of congenital

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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.

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M, 11 yo with torticolis

MRI

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40 yo M with block vertebrae and central canal stenosis

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Fracture dislocation

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Unfused vertebrae

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Non D sra hic S inal Malformations

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au a regress on

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 T1  T2 T2 Fat Sat

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MRI T2 CT Axial

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Right hip Left hip

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6

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