肺性肥大性骨关节病的影像学表现(附1例16年随访报告)

IMAGES OF PULMONARY HYPERTROPHIC OSTEOARTHROPATHY: A 16-YEAR-FOLLOW-UP CASE REPORT

目的探讨肺性肥大性骨关节病的影像学表现及诊断价值。方法追踪观察1例肺性肥大性骨关节病病人16年,对双侧胫腓骨病变行19次X线检查,并行CT、MRI检查。肺部病变行3次X线检查,1次CT检查。结果X线检查双侧胫腓骨下端先后出现层状骨膜增生、骨间膜钙化,自踝关节向膝关节方向逐渐发展,16年后达胫腓骨上端。CT检查显示左胫骨骨皮质明显增厚,骨干中段髓腔局限性消失,骨膜及骨间膜广泛钙化,致使胫腓骨相连。MRI检查除骨膜改变外病变尚累及骨皮质和骨髓腔,骨干皮质信号部分消失,髓腔内显示广泛的异常信号。最终经骨髓腔穿刺病理证实。结论肺性肥大性骨关节病X线检查仅能发现骨膜增生和骨间膜钙化。CT检查可显示髓腔密度不均。MRI检查可显示病变累及骨皮质及骨髓腔。

Objective To discuss the images of pulmonary hypertrophic osteoarthropathy and their diagnostic value. Methods A case of hypertrophic osteoarthropathy was followed up for 16 years. The bilateral tibiofibula osteopathy was examined by X-ray （19 times）, CT and MRI respectively. Pulmonary pathological changes were examined by X-ray （3 times） and CT （1 time） . Results X-ray examinations showed that laminar periosteum hyperplasia and interosseous membrane calcification which were first found on the distal ends of the bilateral tibiofibula progressed towards the knee and 16 years later on the proximal ends of tibiofibula. CT showed obvious incrassation of the cortical bone of left tibia and partial disappearance of the marrow cavity of diaphysis except the extensive calcification of the periosteum and interosseous membrane leading to connection of tibia with fibula. MRI examination found that the partial disappearance of cortical signals and the extensive abnormal signals from the marrow cavity. All the abnormalities were confirmed by pathology. Conclusion In terms of pulmonary hypertrophic osteoarthropathy, X-ray can only detect the periosteum hyperplasia and interosseous membrane calcification, while CT can show changes in the density of marrow cavity, MRI the abnormal signals of cortical bone and marrow cavity.