整形１９

【臨床症状】50代　誘因なく膝痛発生

【問題】画像所見と診断名は？

50009943_2019_01_26_MR_Image001
50009943_2019_01_26_MR_Image002
50009943_2019_01_26_MR_Image003
50009943_2019_01_26_MR_Image004
50009943_2019_01_26_MR_Image005
50009943_2019_01_26_MR_Image006
50009943_2019_01_26_MR_Image007
50009943_2019_01_26_MR_Image008
50009943_2019_01_26_MR_Image009
50009943_2019_01_26_MR_Image010
50009943_2019_01_26_MR_Image011
50009943_2019_01_26_MR_Image012
50009943_2019_01_26_MR_Image013
50009943_2019_01_26_MR_Image014
50009943_2019_01_26_MR_Image015
50009943_2019_01_26_MR_Image016
50009943_2019_01_26_MR_Image017
50009943_2019_01_26_MR_Image018
50009943_2019_01_26_MR_Image019
50009943_2019_01_26_MR_Image020
50009943_2019_01_26_MR_Image021
50009943_2019_01_26_MR_Image022
50009943_2019_01_26_MR_Image023
50009943_2019_01_26_MR_Image024
50009943_2019_01_26_MR_Image025
50009943_2019_01_26_MR_Image026
50009943_2019_01_26_MR_Image027
50009943_2019_01_26_MR_Image028
50009943_2019_01_26_MR_Image029
50009943_2019_01_26_MR_Image030
50009943_2019_01_26_MR_Image031
50009943_2019_01_26_MR_Image032
50009943_2019_01_26_MR_Image033
50009943_2019_01_26_MR_Image034
50009943_2019_01_26_MR_Image035
50009943_2019_01_26_MR_Image036
50009943_2019_01_26_MR_Image037
50009943_2019_01_26_MR_Image038
50009943_2019_01_26_MR_Image039
50009943_2019_01_26_MR_Image040
50009943_2019_01_26_MR_Image041
50009943_2019_01_26_MR_Image042
50009943_2019_01_26_MR_Image043
50009943_2019_01_26_MR_Image044
50009943_2019_01_26_MR_Image045
50009943_2019_01_26_MR_Image046
50009943_2019_01_26_MR_Image047
50009943_2019_01_26_MR_Image048
50009943_2019_01_26_MR_Image049
50009943_2019_01_26_MR_Image050
50009943_2019_01_26_MR_Image051
50009943_2019_01_26_MR_Image052
50009943_2019_01_26_MR_Image053
50009943_2019_01_26_MR_Image054
50009943_2019_01_26_MR_Image055
50009943_2019_01_26_MR_Image056
50009943_2019_01_26_MR_Image057
50009943_2019_01_26_MR_Image058
50009943_2019_01_26_MR_Image059
50009943_2019_01_26_MR_Image060
50009943_2019_01_26_MR_Image061
50009943_2019_01_26_MR_Image062
50009943_2019_01_26_MR_Image063
50009943_2019_01_26_MR_Image064
50009943_2019_01_26_MR_Image065
50009943_2019_01_26_MR_Image066
50009943_2019_01_26_MR_Image067
50009943_2019_01_26_MR_Image068
50009943_2019_01_26_MR_Image069
50009943_2019_01_26_MR_Image070
50009943_2019_01_26_MR_Image071
50009943_2019_01_26_MR_Image072
50009943_2019_01_26_MR_Image073
50009943_2019_01_26_MR_Image074
50009943_2019_01_26_MR_Image075
 

※T2*、プロトン強調、脂肪抑制画像の順に表示

➡ 冠状断
50009943_2019_01_26_MR_Image076
50009943_2019_01_26_MR_Image077
50009943_2019_01_26_MR_Image078
50009943_2019_01_26_MR_Image079
50009943_2019_01_26_MR_Image080
50009943_2019_01_26_MR_Image081
50009943_2019_01_26_MR_Image082
50009943_2019_01_26_MR_Image083
50009943_2019_01_26_MR_Image084
50009943_2019_01_26_MR_Image085
50009943_2019_01_26_MR_Image086
50009943_2019_01_26_MR_Image087
50009943_2019_01_26_MR_Image088
50009943_2019_01_26_MR_Image089
50009943_2019_01_26_MR_Image090
50009943_2019_01_26_MR_Image091
50009943_2019_01_26_MR_Image092
50009943_2019_01_26_MR_Image093
50009943_2019_01_26_MR_Image094
50009943_2019_01_26_MR_Image095
50009943_2019_01_26_MR_Image096
50009943_2019_01_26_MR_Image097
50009943_2019_01_26_MR_Image098
50009943_2019_01_26_MR_Image099
50009943_2019_01_26_MR_Image100
50009943_2019_01_26_MR_Image101
50009943_2019_01_26_MR_Image102
50009943_2019_01_26_MR_Image103
50009943_2019_01_26_MR_Image104
50009943_2019_01_26_MR_Image105
50009943_2019_01_26_MR_Image106
50009943_2019_01_26_MR_Image107
50009943_2019_01_26_MR_Image108
50009943_2019_01_26_MR_Image109
50009943_2019_01_26_MR_Image110
50009943_2019_01_26_MR_Image111
50009943_2019_01_26_MR_Image112
50009943_2019_01_26_MR_Image113
50009943_2019_01_26_MR_Image114
50009943_2019_01_26_MR_Image115
50009943_2019_01_26_MR_Image116
50009943_2019_01_26_MR_Image117
50009943_2019_01_26_MR_Image118
50009943_2019_01_26_MR_Image119
50009943_2019_01_26_MR_Image120
50009943_2019_01_26_MR_Image121
50009943_2019_01_26_MR_Image122
50009943_2019_01_26_MR_Image123
50009943_2019_01_26_MR_Image124
50009943_2019_01_26_MR_Image125
 

T2*、脂肪抑制が像の順に表示

    ▶答えはこちら
    • 各種シーケンスで大腿骨内顆の荷重面に線状の低信号を認める
    • 脂肪抑制画像では、線状所見の周囲に浮腫性変化を認める
    • これらから脆弱性骨折疑いの診断となる
    • 他、内側半月板の前～中節で菲薄化を認める
    ※プロトン強調の冠状断は非提示

    【大腿骨脆弱性骨折】

    ・膝関節の脆弱性骨折は大腿骨内顆に多い（他には、脛骨内側や大腿骨外顆など）

    ・65歳以上の高齢者に多く、骨粗鬆症と関連していると考えられている

    ・荷重部に生じやすく、半月板損傷を伴う事も多い

    ・関節面圧潰を認める事から、特発性骨壊死の前駆状態と推測されている

    ・圧潰の原因は不明な事が多い

    ・保存的治療で軽快することも多い

    骨軟部疾患の画像診断 第2版より