Caso cerrado: 7 nov
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Transcript of Caso cerrado: 7 nov
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CASO CERRADO
7 de Noviembre de 2013
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Historia: Varón de 70 años con dolor en en el hombro
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En resumen
• Cambios degenerativos y osteoartritis• Expansión de las bursas• Esclerosis• Multiples calcificaciones intrabursales• Forma y tamaño irregular• Disminución del espacio articular
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DDx
• Condroma intraarticular• Sinovitis villonodular pigmentada• Osteocondromatosis sinovial primaria• Osteocondromatosis sinovial secundaria• Condroma periostal o de partes blandas• Hombro de Milwoukee
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CONDROMA INTRAARTICULAR
• Masa tejido blando
• Hoffa• Calcificacion de la
matriz condroide
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CONDROMA INTRAARTICULAR
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SINOVITIS VILLONODULAR PIGMENTADA
• > Rodilla• Gran efusión• Densidad osea
normal• Cartilago preservado• Quistes subcondrales• Erosiones oseas
visibles 50%• Cuerpos no visibles
en Rx• Rodilla>tobillo>cader
a>hombro
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SINOVITIS VILLONODULAR PIGMENTADA
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OSTEOCONDROMATOSIS SINOVIAL PRIMARIA
• Cuerpos óseos-cartilaginosos
• Múltiples y redondos
• Conglomerados• Grados
diferentes de Ca• Puede haber
erosiones• Osteopenia
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OSTEOCONDROMATOSIS SINOVIAL PRIMARIA
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OSTEOCONDROMATOSIS SINOVIAL SECUNDARIA
• Coexiste osteoartritis
• Diferente tamaño y forma
• Dism. del espacio subcondral y articular
• Osteofitos
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CONDROMA PERIOSTAL
• Tumor condroide• Clave dx: lesion
superficial de la metáfisis
• Produccion de matriz condroide
• Esclerosis• 2º y 4º décadas• Festoneado
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CONDROMA PERIOSTAL
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Hombro de Milwaukee
• Cristales de hidroxiapatita
• Calcificación homogénea- tendón y bursa
• Globular• No trabeculación• 4º y 5º decasas• Asintomatica ó Sx
inflamatorios locales
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HOMBRO DE MILWAUKEE
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70 a. Dolor
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OSTEOCONDROMATOSIS SINOVIAL,
SECUNDARIA