KRITIČNA ANALIZA ČLANKOV
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1 KRITIČNA ANALIZA ČLANKOV RADIOLOŠKO UGOTOVLJENE KALCINACIJE MEHKIH TKIV V POVEZAVI Z EKSPANZIVNIMI PROCESI Barbara Eugenija Jamnik, Branka Mrvalj Rajterič, Lara Panič Prelog, Maja Kolšek-Šušteršič
2 OPIS KLINIČNEGA PRIMERA! 40 letna bolnica, do sedaj zdrava, po poklicu čistilka! 3 tedne trajajoče bolečine pod d. kolenom! Status: blaga palpatorna občutljivost nad tuberositas tibiae! NSAID, RTG d. kolena in goleni! Po 14 dneh ni izboljšanja, na RTG vidne številne drobne kalcinacije mehkih tkiv v zgornjem sprednjem delu d. goleni! Radiolog: kalcinacije verjetno vnetne etiologije, manj verjetno ekspanzivni proces
3 KLINIČNO VPRAŠANJE! Kakšna je diferencialna diagnoza pojava kalcinacij mehkih tkiv in ligamentov ter kako pogoste so?! Ali je kalcinacija mehkih tkiv povezana z ekspanzivnimi procesi in katerimi?
4 RELEVANTNOST PROBLEMA! Kalcinacije mehkih tkiv in ligamentov pogosta patologija v ambulanti druž. zdravnika! Naključno odkritje ob RTG diagnostiki ali v sklopu diagnostike simptomatike, ki je povezana s kalcinacijami! Bolečina v sklepu in omejena gibljivost: kalcinacija pogosto edina odkrita sprememba! Povezava z ekspanzivnimi procesi namigi klin. specialistov, problematično tolmačenje
5 PREGLED ČLANKOV IN VIROV! Slabo raziskana tematika! Predmet raziskovanja radiologov, onkologov in ortopedov! Iskalniki: MedLine, UBM Medica Network področje radiologije! Ključne iskalne besede: kalcinacije, koleno, mehka tkiva, tendinopatije, onkologija, tumorji, ekspanzivni procesi
6 PRIPOROČILA ZA PRAKSO! V literaturi premalo podatkov o povezavi odkritih kalcinacij mehkih tkiv z redkimi ekspanzivnimi procesi! Verjetno v sklopu diagnostike malignih obolenj najdba kalcinacije ni prva najdba, ampak se prej pojavijo drugi bolj zaskrbljujoči simptomi in znaki, kalcinacijo odkrijemo naknadno (dodatno)! 95-98% je klacifikacija distrofičnega mehkega tkiva, ki je povezana s poškodbo
7 POVZETEK! Povezava z ekspanzivnimi lezijami?! CT in MRI pomembna v diferencialni diagnostiki! Značilen izgled kalcinacij pri določenem tipu tumorja
8 POVZETEK! DD kalcinacij! Etiopatogeneza ni povsem jasna! V povezavi z: distrofijo mehkih tkiv (95-98%), hondrokalcinozo (1-2%), kalciniranimi metastazami, metastazami osteosarkoma in prim. osteosarkomom! Klinična slika DD podobna osteoartritisu, destruktivnim artropatijam in tendinitisu! V 44% po op. kolena! Kalcifirajoča mionekroza! Vezivno-tkivne bolezni juvenilni dermatomiozitis, sistemska skleroza
9 DIFERENCIALNA DIAGNOZA! Travma primarna ali po operaciji! Neoplazme osteom, osteosarkom redko!! Vaskularne kalcinacije venska insuficienca! Infekcijske tkivni paraziti! Zdravila! Nekatera avtoimusnka obolenja skleroderma, dermatomiozitis
10 ČLANKI! 1. Ea HK, Liote F. Diagnosis and clinical manifestations of calcium pyrophosphate and basic calcium phosphate chrystal deposition deseases.! Rheum Dis Clin North Am. Maj 2014; 40(2): (PubMed)! 2. Beebe JA, Cross PS. Patellar tendinopathy: preleminary surgical results. Sports Health. Maj 2013; 5(3): (PubMed)! 3. Oliva F, Via AG, Maffuli N. Physiopathology of intratendinous calcific deposition.! BMC Med. Avgust 2012;(4): 10:95. (PubMed)! 4. White WJ, Sarraf KM, Schranz P. Acute calcific deposition in the lateral collateral ligament of the knee. J Knee Surg. December 2013; 26 Suppl 1:S (PubMed)! 5.Paparo F, Ameni P, Denegri A, Revelli M, Muda A, Garlaschi G, Cimmino MA. Multimodal imaging in the differential diagnosis of soft tissue calcinosis.! Reumatismo. November 2011; 63(3): (PubMed)! 6. Chen CK, Wu HT, Chiou HJ, Wei CJ, Yen CH, Chang CY, Chen WM. Differentiating benign and malignant soft tissue masses by MRI: role of tissue component analysis. J Chin Med Assoc. April 2009; 72(4): (PubMed)
11 ČLANKI! 7. Wilkerson BW, Crim JR, Hung M, Layfield LJ. Caracterisation of synovial sarcoma calcification. AJR Am J Roentgenol. Dec 2012; 199(6):W (PubMed)! 8. Park JH, Kang CH, Kim CH, Park JH. Higly malignant soft tissue sarcoma of the extremity with delayed diagnosis. World J Surg Oncol. September 2010; 8:84. (PubMed)! 9. Schonauer F, Avvedimento S, Molea G. Calcifying aponeurotic fibroma of the distal phalanx. J Plast Reconstr Aesthet Surg. Februar 2013; 66(2):e47-9. (PubMed)! 10. Muramatsu K, Ihara K, Seki T, Imagama T, Taguchi T. Calcific myonecrosis of the lower leg: diagnosis and options of treatment. Arch Orthop Trauma Surg.. Julij 2009; 129(7): (PubMed)! 11. Chander S, Gordon P. Soft tissue and subcutaneous calcification in connective tissue diseases. Curr Opin Rheumatol. Marec 2012; 24(2): (PubMed)! 12. Masciocchi C, Lanni G, Conti L, Conchiglia A, Fascetti E, Flamini S, Colleti G, Barile A. Soft-tissue inflammatory myofibroblastic tumors of the limbs: potential and limits of diagnostic imaging. Sceletal Radiol. Junij 2012; 41(6): (PubMed)
12 HVALA ZA POZORNOST!
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