整形５７

【臨床症状】20代　足関節痛精査

【問題】画像所見と診断名は？

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※ T2WI、T1WI、脂肪抑制の矢状断、T2WI、脂肪抑制の横断像の順に表示

    ▶答えはこちら
    • 脛骨の遠位部にT1WIで低信号、T2WIで一部高信号の地図上の信号域を認める
    • 脂肪抑制画像では骨髄内や周囲の皮下組織に浮腫性変化を認める
    • 炎症は脛骨に限局しており、距骨の信号変化は認めない
    • 上記より（慢性）骨髄炎が疑われる
    左から脂肪抑制、T1WI、T2WI

    【骨髄炎】

    ・骨髄炎には急性骨髄炎と慢性骨髄炎がある

    <急性骨髄炎>

    • 急性骨髄炎は黄色ブドウ球菌によるものが多い
    • 小児に多く、好発年齢は10代
    • 小児では長管骨の骨幹端に好発し、成人では脊椎や骨盤、足骨に発生する事が多い
    • 小児で長管骨に多い理由は、血液ループにより血流遅延が起こりやすいためと考えられている
    • 成人発症の場合は、糖尿病などの基礎疾患がある場合に多い
    • 初期では単純写真では指摘が難しく、MRIが有効

    <慢性骨髄炎>

    • 急性化膿性骨髄炎から移行する場合（定型骨髄炎）と、最初から慢性経過を示すもの（非定型骨髄炎）がある
    • 非定型骨髄炎は、抵抗力が強い場合に弱毒性菌感染が見られる場合に多いと言われている
    • 画像所見は、骨硬化や肉芽腫病変に囲まれた境界明瞭な液体貯留（膿瘍）を含む場合が多い
    • 他の所見としては、骨破壊、骨硬化、骨皮質肥厚、骨膜反応など
    • ただこれらの所見は非特異的なものが多く、他の臨床所見やデータなどを参考に診断する事が重要である
    参考書籍：骨軟部疾患の画像診断 第2版