Kaburga osteomiyeliti BT bulguları

Özet

Kaburga osteomiyeliti nadirdir; hematojen yayılımla, künt göğüs travması sonrasında veya plevral enfeksiyonun göğüs duvarına yayılımıyla gelişebilir. Kontrastlı toraks BT'sinde kaburgada fokal litik değişiklikler, kaburgaya bitişik yumuşak doku koleksiyonu ve kemiğe invazyon göstererek enfeksiyonun yayılımını ve eşlik eden koleksiyonu haritalar. Çocuk kaburga osteomiyeliti serisinde kemik iliği sinyal anormallikleri 8 MR incelemesinin tümünde görülmüş; bu nedenle MR, kemik iliği tutulumunu değerlendirmede yararlı olabilir. Kaburgaları invaze eden göğüs duvarı kitlesi osteomiyelit olabilir; kitleyi yalnız yumuşak doku bulgusu olarak değerlendirmek kaburga tutulumunu gözden kaçırabilir.

Faz ve pencere

Kemik rekonstrüksiyonu tanısal: İnce kesit kemik rekonstrüksiyonunda etkilenen kaburgada fokal litik erozyon ve kortikal düzensizlik aranır; erken kemik iliği hastalığı için MR daha duyarlıdır ve görüntüleme negatifliği enfeksiyonu dışlamaz.
Portal tanısal: Kontrastlı toraks BT'sinde kaburgaya bitişik flegmon veya koleksiyon, çevresel duvar kontrastlanması, cilt altı ve kas planlarında inflamasyon ile plevral/akciğer odağından doğrudan devamlılık değerlendirilir.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40), Mediasten (G 350 / M 50), Akciğer (G 1500 / M -600).

BT bulguları

Kaburga korteksinde fokal silinme, düzensizlik veya erozyon; komşu normal kemik boyunca keskin sınırlı görünümün kaybı.
Litik dejenerasyon ve kortikal bütünlükte bozulma enfeksiyonun ilerlemesiyle ortaya çıkar.
Periostal yeni kemik oluşumu veya korteksten ayrılmış yoğun kemik parçası olarak sekestr.
Tutulan kaburgaya bitişik pektoralis, interkostal veya subkutan yumuşak dokuda kalınlaşma ve inflamatuvar kitle.
Komşu yumuşak dokuda düşük atenüasyonlu koleksiyon ve kontrastlanan duvar; eşlik eden göğüs duvarı apsesi.
Plevral kalınlaşma, ampiyem veya komşu akciğer enfeksiyonu ile kaburga çevresindeki inflamasyonun devamlılığı.
Tek kaburgada fokal tutulum ya da birden fazla kaburga segmentinde yaygın destrüksiyon; enfeksiyon odağının kompartıman ilişkisi.

Normalde

Normal kaburgada kortikal çizgi kesintisiz ve düzgün izlenir; periostta kabarık yeni kemik, fokal litik alan veya kaburga çevresinde inflamatuvar yumuşak doku kitlesi bulunmaz. Şüpheli kaburga segmentinde korteksi ve komşu yumuşak dokuyu, plevradaki eşlik eden değişikliklerle birlikte değerlendir.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s1278; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Kaburga metastazı: medüller litik veya sklerotik odak ve yumuşak doku kitlesi yapabilir; çoklu kemik lezyonları ya da bilinen primer tümör bağlamı enfeksiyondan ayırmaya yardım eder.
Primer kemik tümörü: agresif periostal reaksiyon, geniş geçiş zonu ve kaburgadan kaynaklanan yumuşak doku komponenti görülebilir; BT tek başına enfeksiyonu kesin dışlamaz.
İyileşen kaburga kırığı: kortikal kallus ve düzenli kırık hattı oluşturur; eşlik eden periostal şekillenme travma hattını izler, komşu apse beklenmez.
Kronik fibröz displazi: kaburgada ekspansil, buzlu cam matriksli lezyon ve düzgün kortikal incelme yapabilir; çevre inflamatuvar koleksiyon tipik değildir.
Tüberküloz kostal tutulum: kaburgada kemik yıkımı ve göğüs duvarı soğuk apsesi görülebilir; bu bulgular tanıyı düşündürse de tek başına özgül değildir.

Tuzaklar

Kaburga osteomiyelitli çocuklardan oluşan bir seride litik değişiklikler 8 BT incelemesinin 4’ünde, kemik iliği sinyal anormallikleri ise 8 MR incelemesinin tümünde görülmüştür; bu nedenle BT’de belirgin kemik değişikliği olmaması osteomiyeliti dışlamaz.
İyileşen kırıkta kallus periostal reaksiyon taklidi yapar; kortikal kırık hattını ve kaburga boyunca kallusun düzenli yeniden şekillenmesini ara.
Kaburga yumuşak doku kitlesi metastaz veya primer tümör de olabilir; kemik yıkımını otomatik olarak enfeksiyona bağlama, koleksiyon duvarı ve komşu enfeksiyon odağını değerlendir.

Kendini dene

Kaburgada kortikal erozyon ve periostal yeni kemik, bitişik kontrastlanan yumuşak doku koleksiyonuyla birlikte görülüyor. En olası tanı nedir?
Cevabı göster
Kaburga osteomiyeliti. Kortikal destrüksiyon ve periostal yanıtın bitişik enfeksiyöz koleksiyonla birlikteliği kaburga osteomiyelitini destekler. İyileşen kırıkta kallus ve kırık hattı beklenir; fibröz displazi matriksli ekspansil lezyondur, kostokondrit kemik korteksini bu şekilde yıkmaz.
Çocuklarda kaburga osteomiyeliti serisinde litik değişiklikler kaç BT incelemesinde saptanmıştır?
Cevabı göster
4/8. Seride litik değişiklikler 8 BT incelemesinin 4’ünde saptanmıştır.

İlgili konular

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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