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Lesões ósseas
Doenças articulares
DIAGNÓSTICO POR IMAGEM
M.V., Esp. MSc., Andressa Cristina de Souza
LuminaVet Diagnóstico por Imagem Veterinária
CENTRO INTEGRADO DE ESPECIALIDADES VETERINÁRIAS
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Esqueleto ___________________________________
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» Esqueleto Axial ___________________________________
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• Crânio ___________________________________
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• Coluna ___________________________________
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• Pelve ___________________________________
» Esqueleto Apendicular ___________________________________
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•Membros torácicos ___________________________________
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•Membros pélvicos ___________________________________
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Ossos Longos ___________________________________

» Forma tubular
» Comprimento > largura e espessura
» Divididos:
1. média = Corpo ou Diáfise
2. Duas extremidades = Epífises
» Jovens possuem separação entre as epífises
e a diáfise denominada Metáfise
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Respostas ósseas a lesão ___________________________________

» Focal, Multifocal ou Generalizada
» Aumento da radiopacidade óssea (esclerose) –
produção/proliferação
» Redução da radiopacidade óssea - reabsorção/lise
» Alteração de tamanho e forma – Fratura ou fechamento
precoce da placa fisária
» Reação periosteal
» Agressivas x não agressiva
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 Reação periosteal
Reabsorção/Lise

Produção/proliferação

Nomenclaturas de Lesão Óssea
» Redução da radiopacidade óssea – reabsorção/lise
» Generalizada = OSTEOPENIA
» Focal = LISE ÓSSEA
 Geográfica: área focal de lise com margens bem
definidas (cistos) - Menos agressiva
 “Roído de traça”: múltiplas áreas de lise de tamanhos
variados (tumor e infecção)
 Permeativa: áreas focais de osteólise mal definidas -
Mais agressiva.
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Diminuição da radiopacidade óssea
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» Osteopenia » Lise óssea ___________________________________

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Padrões de lise óssea

Geográfica Roído de traça Permeativa

Foto: Rosana Zanatta

Tipos de reação periosteal
» Lamelar (casca de cebola)
Fonte: Owens,___________________________________
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Tipos de reação periosteal
» Irregular ou Paliçada
Fonte: Owens, J.M.,___________________________________
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1982.

Tipos de reação periosteal
» Espiculada ou radiada
Foto: Tilde Froes
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Fonte:___________________________________
Owens, J.M., 1982.
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Tipos de reação periosteal

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» Amorfa ou explosão solar

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Tipos de reação periosteal
» Triângulo
Fonte: Owens, J.M., 1982.
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de Codman
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Lesões agressivas x não agressivas
» Zona de transição entre lesão e osso normal:
– Não agressiva: distinta, definida
– Agressiva: mal definida
» Tipo de reação periosteal:
– Laminada < Paliçada < Radiada < Amorfa
» Destruição cortical:
– Agressiva
» Radiografias seriadas
– Agressivas: destruição rápida
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Osteomielite ___________________________________
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»Sinais radiográficos:
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1. Atravessa articulação ___________________________________
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2. Reação periosteal laminar e paliçada ___________________________________
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3. Lise - geográfica ___________________________________
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4. Destruição cortical – em casos severos ___________________________________
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Neoplasias Ósseas Malignas
»Sinais Radiográficos:
1. Não envolve articulação adjacente
2. Padrão radiográfico agressivo
3. Zona de transição mal definida
4. Reação periosteal amorfa/ explosão solar
5. Atividade osteolítica e osteoblástica
6. Destruição cortical
7. Fraturas patológicas
» Metástase pulmonar
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Fraturas
Definição:
» Solução , descontinuidade ou quebra da
continuidade uma estrutura óssea
» Caracterizada por uma linha radioluscente
» Alteração do alinhamento, forma, tamanho e
posição
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Avaliação Radiográfica da Fratura
» Osso envolvido (diáfise, metáfise ou epífise)
» Grau de deslocamento
»
Número de fraturas
» Direção da linha de fratura
» Envolvimento articular (intra-articular,
fragmentos, luxação e subluxação)
» Grau de rotação
» Tecidos moles adjacentes
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Classificação ___________________________________
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1. Integridade dos tecidos moles ___________________________________
» Aberta (áreas radiolucentes em tecidos ___________________________________
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moles - ar) ___________________________________
» Fechada ___________________________________
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» Risco de infecção
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» Osteomielite ___________________________________
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Classificação ___________________________________
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2. Descrição extensão e direção da fratura ___________________________________
» Incompleta (só atinge uma cortical) ___________________________________
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» Completa (atinge as 2 corticais) ___________________________________
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o Transversa ___________________________________
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o Oblíqua ___________________________________
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o Espiral ___________________________________
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3. Descrição geométrica e número de ___________________________________
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fragmentos ___________________________________
» Simples ___________________________________

» Cominutiva – várias linhas que se

convergem entre si
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Classificação ___________________________________
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4. Salter-Harris - descreve fraturas na região da cartilagem epifiseal –
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Classificação
4. Fraturas múltiplas
5. Fraturas em galho verde
6. Fraturas por avulsão
7. Fraturas patológicas
8. Fraturas em lasca
9. Fraturas por compressão
10. Fraturas em depressão
11. Fraturas envolvendo articulação
12. Fraturas em fissura
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Complicações das fraturas
1. Má união
» Ocorreu a cicatrização óssea, porém
em posicionamento inadequado
» Causa impotência funcional do
membro e DAD – Doença Articular
Degenerativa
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Complicações das fraturas
2. União Retardada
» Cicatrização demora mais que 45 dias *
3. Não união
» Não há mais formação de calo ósseo
» Esclerose das superfícies medulares nos
fragmentos da fratura – selo da medular
» Atrófica e hipertrófica
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Doenças articulares
» Osteoartrose
» Osteoartrite
» Displasia coxofemoral
» Necrose asséptica do fêmur
» Luxação de patela
» Insuficiência do ligamento cruzado
» Displasia do cotovelo
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Radiologia Osteoarticular
Indicações:
» Trauma
» Deformidades congênitas
» Doenças do desenvolvimento
» Doenças degenerativas
» Doenças metabólicas
» Doenças inflamatórias
» Neoplasias
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OSTEOARTRITE
» Primária – inflamações severas
o Infecciosas ou imunomediadas
» Secundária a outras doenças
» A lesão primária acontece na cartilagem
• Lesão do osso subcondral
• Detecção de esclerose e lise óssea
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DOENÇA ARTICULAR DEGENERATIVA
» Osteoartrose – Degeneração
• Condição não inflamatória
Fissura e fragmentação da cartilagem articular
» Ineficiência na proteção do osso subcondral
» Neoformação óssea ao redor das margens da
articulação
» Osteófitos e enteseófitos
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DOENÇA ARTICULAR DEGENERATIVA - DAD

1- Efusão articular
2- Osteófitos
3- Enteseófitos
4- Esclerose e erosão osso subcondral
5- “Joint mice”
6- Aumento de opacidade do osso
subcondral
7- Cisto ósseo subcondral
OSTEOARTRITE

DISPLASIA COXOFEMORAL
» Alteração dos tecidos conectivos da articulação
» Desenvolvimento anormal da articulação
coxofemoral
» Doença relativa ao crescimento e ao
desenvolvimento
» Afeta cães de porte grande
» Hereditariedade - Genotípica
» Dieta alimentar, meio ambiente - Fenotípica
» Grau de exercícios físicos - Fenotípica
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DISPLASIA COXOFEMORAL
» Dispariedade entre massa muscular e crescimento
ósseo
» Altera a biomecânica da articulação - instabilidade
» Fatores causam a inflamação da membrana sinovial
» Relaxamento do ligamento redondo e flacidez da
cápsula
» Incongruência da articulação levando a DAD
» Dor e claudicação
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NORMAL DISPLASIA COXOFEMORAL + DAD

DISPLASIA COXOFEMORAL
Ventrodorsal em extensão
 Membros tracionados e patela em sulco troclear
 Ilio e forames obturadores alinhados
»
A partir de 18 a 24 meses
» Não avalia a flacidez da cápsula articular
» Avalia congruência articular e DAD
» Não descarta completamente displasia em
animais com idade < 2 anos
» Ângulo de Norberg ≤ 105◦
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NORMAL

Sinais radiográfico
» Incongruência - Subluxação ou luxação
» Sinais de DAD
o Arrasamento e esclerose do acetábulo
o Linha de Morgan (reação periosteal inicial)
o Colo femoral espesso e irregular (colar de
osteófitos pericondrais)
o Achatamento e irregularidade da superfície
da cabeça do fêmur
o Osteófitos e enteseófitos
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NORMAL DISPLASIA COXOFEMORAL + DAD
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PennHip ___________________________________
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» A partir de 3 meses ___________________________________

» Usa-se distrator
o Índice de distração = quanto a cápsula é
flácida
» Cálculo do DI - até 0,4 Pastor Alemão
- até 0,3 Labrador e Rottweiler
http://www.pennhip.org/resch_sum.html
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NECROSE ASSÉPTICA DA CABEÇA DO FÊMUR
» Espontânea
» Hereditária
» Raças de pequeno porte
» Trauma
» Ocorre isquemia na cabeça femoral
» Claudicação – uni ou bilateral
» Idade de 4 a 10 meses de idade
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Sinais radiográficos
» Áreas de opacidade óssea diminuída – resultantes
da lise óssea na cabeça femoral
» A cabeça do fêmur perde seu contorno -
arredondado e achatada
» Arrasamento acetabular – pode haver subluxação
» Sinais de DAD
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JOELHO - LUXAÇÃO DE PATELA
» Bilateral em 50% dos casos
» Claudicação – flexão intermitente
» Apoio em pinça
» Desvio do eixo ósseo
» Cães pequenos – 80% medial
» Cães grande porte – lateral
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INSUFICIÊNCIA DO LIGAMENTO CRUZADO
» Agudo ou crônico
» Instabilidade da articulação do joelho
» Causa comum de claudicação
» Causa mais comum de DAD
» Diagnóstico clínico – TESTES ORTOPÉDICOS
• Movimento de gaveta
• Teste tibial cranial
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INSUFICIÊNCIA DO LIGAMENTO CRUZADO
Sinais radiográficos SECUNDÁRIOS
» Efusão articular
» Deslocamento cranial da tíbia proximal
» Sinais de DAD crônico
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DISPLASIA DO COTOVELO ___________________________________

1. Incongruência articular
Subdesenvolvimento da
Assincronia de crescimento
incisura troclear ulnar
IMAGENS: BURTON & OWEN, 2008.
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DISPLASIA DO COTOVELO
2. Não união do processo ancôneo > 150 dias
» Linha de separação radioluscente com margens
escleróticas é visualizada entre o processo ancôneo e a
ulna
Foto: Alexandre Schmaedecke
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DISPLASIA DO COTOVELO
3. Não união (ou fragmentação) do processo
coronóide medial da ulna
» Pode não ser visualizado em radiografia
normais devido a sobreposição
» Lateral flexionada e oblíqua
» Lesão cartilagem não visível ao RX – DAD
» Tomografia
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 PROCESSO CORONÓIDE NORMAL

Diagnostic Imaging of Canine Elbow Dysplasia: A Review COOK, C. R. et al Veterinary Surgery 38:144–153, 2009
 FRAGMENTAÇÃO DO PROCESSO CORONÓIDE

Diagnostic Imaging of Canine Elbow Dysplasia: A Review COOK, C. R. et al Veterinary Surgery 38:144–153, 2009
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DISPLASIA DO COTOVELO ___________________________________

4. Osteocondrite dissecante do epicôndilo medial
do úmero
» Falha na ossificação subcondral
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» Rara
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» Tomografia ___________________________________
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Testando seus conhecimentos
» Fraturas fisárias envolvem uma cartilagem fisária
aberta e são descritas com o sistema de classificação
de Salter-Harris. Cinco classes foram originalmente
descritas com base no envolvimento da epífise,
cartilagem fisária e metáfise. A classificação para uma
única fratura na cartilagem fisária:
a. Fraturas Salter-Harris tipo I;
b. Fraturas Salter-Harris tipo II;
c. Fraturas Salter-Harris tipo III;
d. Fraturas Salter-Harris tipo IV;
e. Fraturas Salter-Harris tipo V.
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Testando seus conhecimentos
» Um termo para descrever um tipo de reação
periosteal é o chamado “Triângulo de
Codman”, onde operiósteo é elevado e se
distancia do córtex. Ele pode ser observado em
radiografias de:
a. Osteossarcoma;
b. Lesões infecciosas e traumáticas;
c. Lesões benignas;
d. Apenas as alternativas “a”e “b” estão corretas;
e. As alternativas “a”, “b” e “c” estão corretas.
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Testando seus conhecimentos
» Ao avaliar o exame radiográfico de um cão poodle toy,
macho de 1 ano de idade, na projeção VD da pelve,
você detectou: áreas de osteólise (reabsorção óssea)
em cabeça de fêmur direito, causando deformação
dessa estrutura, subluxação em relação ao acetábulo e
atrofia muscular. Frente a esses achados clínicos e
radiográficos, a enfermidade provável é:
a) Displasia coxofemoral unilateral.
b) Displasia epifisária com deslizamento da cabeça
femoral unilateral.
c) Retenção da cartilagem da cabeça femoral unilateral.
d) Necrose asséptica da cabeça femoral unilateral.
e) Agenesia da cabeça femoral unilateral.
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