軟組織鈣化審校這里是播客26第1部

[0:09.1]ThisisPodcast26fromLea :SoftTissueCalcifications,Part1. [0:17.1]o,I'mWilliamHerringfromAlbertEinsteinMedicalCenterinPhiladelphia.[0:21.8]Softtissuecalcificationshavebeendividedinto4[0:25.7]dystrophiccalcification,metastaticcalcification,calcinosisand damagedordegeneratingtissue.[0:38.7]Thereisusuallynoassociatedmetabolic[0:42.9]Thisisanexampleofcalcificationinwhathavebeenalargehematomaintheleftglutealarea.[0:51.6]Metastaticcalcificationsarecalcificationswhichoccurpreviouslynormal[0:58.1]Theyarefrequentlyassociatedwithmetabolic[1:01.5]Anddespitehavingthename"metastatic"associatedwiththem,theyhavenothingtodowithmalignancy.，[1:08.0]ThisisanexampleofcalcificationaroundtheelbowinapatientwithhypervitaminosisD.[1:17.3]Calcinosisiscalcificationofcutaneous,subcutaneous,ordeepconnectivetissue.[1:24.1]Thereisusuallynoconsistentmetabolic[1:27.7]Andthereisaninconstantassociationwithcollagen-vascular[1:33.6]Thisisanexampleofthesheet-likecalcificationthat'susuallyseenwithcalcinosisuniversalis(全身性鈣質(zhì)沉著)indermatomyositis.[1:44.2]Thereare3typesofcalcinosis:calcinosiscircumscripta calcinosisuniversalis,andtumoral[1:52.9]Inthispodcast,we'regoingtodiscusscalcificationrelatedtojoints,calcificationswithinhands,diffusecalcificationandossification,calcificationsassociatedwithvasculardiseaseandmyositis.[2:08.8]Inthenextpodcast,we'lldiscusscalcificationorossificationrelatedtotumors,metastaticcalcification,calcificationassociatedwithparasites,miscellaneousdiseases.[2:19.9]Andthere'llbeanexpandedquizafterthenext[2:23.9]Calcificationrelatedto[2:26.9]Chondrocalcinosisiscalcificationofarticular[2:31.2]Ingout,thecalciumiscalciumurate[2:35.7]Inpseudogout,thecalcificationiscalcium[2:40.4]Incalciumpyrophosphatedepositiondisease(CPPD),thecalciumiscalciumpyrophosphate.在CPPD（焦磷酸鈣沉積癥[2:45.6]Inochronosis(褐黃病),araredisease,thecalcificationoccursbecauseofdeficiencyinhomogentisicacidoxydase(尿黑酸氧化酶).褐黃病是一種罕見的疾病，其鈣化的產(chǎn)生是因?yàn)槟蚝谒嵫趸傅娜盵2:53.5]Inhyperparathyroidism,especiallysecondaryhyperparathyroidism,therecanbesofttissuecalcificationsincludingarticularcartilage.[3:03.1]Chondrocalcinosiscanoccurindiabetics,andassociatedwithdegenerativedisease.[3:09.3]Chondrocalcinosisismostcommoninthe[3:12.3]Ithas(is)alsoseencommonlyinthesymphysispubis,inthehips,inthetriangularfibrocartilageatthedistalendoftheulna,andintheshoulders.[3:21.9]Thisisanexampleofchondrocalcinosisinthekneeinapatientwhohaswarmth,swellingandtenderness,allsignsofinfltionaroundthekneeandwhohaspseudogout.[3:33.1]Youcanseethereisathin,curvelineardensitythatparallelstheendofthedistalfemurandrepresentscalcificationinthedistalfemoralarticularcartilage.[3:44.6]Thisisapatientwithcalcificationinthetriangularfibrocartilageatthedistalendoftheulna.[3:50.6]Thispatienthascalciumpyrophosphatedeposition該患者患有CPPD（焦磷酸鈣沉積癥[3:55.8]Andthisisanexampleofcalcificationofthesymphysis[4:00.2]Thisisacommonlyseenareaforchondrocalcinosisandmaynotnecessarilybeassociatedwithotherdiseases.[4:08.9]Tumoralcalcinosisinitsoriginformisafamilial,polyarticulardiseasewhichoccursmostlyinAfrican-Americans.[4:17.2]Itproduceslargemultiloculatedcysticcollectionsofcalciuminornearjoints.[4:23.7]Thesecollectionsareusually[4:26.5]Buttheymaygrowlargeenoughtocausepainfromnervepressureandtheycanulcerateand esecondarilyinfected.[4:33.6]Tumoralcalcinosisisalso eatermusedinassociationwithaformofcalcificationinandaroundjointsassociatedwithchronicrenaldisease.[4:45.2]Thisisanexampleoftumoralcalcinosisaroundthe[4:49.0]Youcanseethattherearetheselarge,softratherflocculent(?)masseswhichcontaincalciumhydroxyapatite（）,phosphate（磷酸鹽）carbonate（碳酸鹽）crystalsinsuspension（懸[5:00.0]Frequently,ifaradiographisattainedusinghorizontalbeamoronCToronMRI,通常，在水平投或CT或MRI上[5:07.0]theremaybeafluid-fluidleveldemonstratedasthecalciumcrystalscomeoutofsuspension.[5:14.3]Synovialchondromatosisrepresentsametasiaofsynovialconnectivetissueintocartilage,althoughitmay ebone.[5:22.8]Itusuallyaffectstheknee,hip,and[5:26.0]Ittendstobemono-[5:28.1]Itcanbethecauseofaloose[5:30.8]Anditisdividedfrequentlyintoaprimaryandasecondary[5:35.0]Theprimaryformislesscommon.[5:37.6]Thecalcificationstendtobemoreuniforminsizeandadjacentjointisusually[5:43.0]Thesecondaryformismorecommon.Itismostfrequentlyassociatedwithosteoarthritis-degenerativejointdisease.[5:49.9]Andthecalcificationstendtobefewerinnumberandvaryin[5:55.7]Thisisanexampleofprimarysynovial[6:00.3]You'llseetherearenumerouscalcificationsinaringandarch(?)configurationthatsurroundthekneejoint.[6:07.3]Theytendtobesomewhathomogenousin[6:12.4]Calcifictendonitismostcommonlyisseenintheshoulder,inthelongheadofthebicepstendonorinthesubacromialbursa.[6:19.6]Itmaybeassociatedwithacutepain,swellingandpoint[6:24.6]Themechanismisbelievedtobeduetodegenerationandinfltionofthetendonwithsubsequentdepositionof[6:35.0]Thisisanexampleofcalcifictendonitisinvolvingthe[6:39.5]Thereisathickcurvelinearcalcificationthatparallelsthehumeralhead inthepositionofthelongheadofthebicepstendon.[6:49.3]Goutytophiaredepositsofmonosodiumuratecrystalsinprotein,lipid,andpolysaccharide(s).[6:56.5]Theyareusuallysurroundedbygiantcellforeignbody[7:00.4]Theycanoccurinperi-articularsofttissueswherewe’remostusedtoseeninthem.[7:05.4]butalsoinbursae,andligaments,tendons,eye,ear,nose,throatorskin.[7:10.4]Visiblecalcificationoccursinabout50%ofallgouty[7:15.2]Thisisanexampleofgoutytophithatarepartiallyinvolvingboththerightandleftmetatarsal-phalagealjointsofthegreat metatarsal-phalagealjoints[7:29.8]andtherearelargesofttissuemassesassociatedwiththeerosionswhichareslightlydenserthanthesurroundingtissue.[7:38.0]Calcificationwithin[7:40.6]Calcinosiscircumscriptarepresentscutaneousorsubcutaneous[7:46.2]Ithasadistinctivesharplymarginated,punctateappearanceinthefingers.[7:51.8]Itisalmostalwaysassociatedwith [8:00.9]Thisisanexampleofcalcinosiscircumscriptainthehandinapatientwithscleroderma.[8:07.1]Theredarrowsarepointingtosmall,punctate,verydensecalcificationsthatareadjacenttojoints.[8:14.4]Thispatienthasosteopeniaandflexiondeformityofthe[8:20.5]Diffusecalcificationand[8:24.1]Calcinosisuniversalishasanunknownetiology,althoughitisfrequentlyassociatedwithcollagen-vasculardisease,especially[8:34.3]Theclinicalsymptomsdependonwhichorgansareinvolvedbythecollagen-vasculardisease.[8:40.2]Andthereisusuallynormalbloodchemistryassociatedwith[8:44.5]Calcinosisuniversalistendstolooklikemyositis[8:48.6]Butthereisnotrueboneformedincalcinosis[8:54.7]Initially,thecalcificationcanbesuperficialandnodularor[8:59.7]Butlater,thedeepertissuescalcifyandthecalcification moresheet-likeandperi-articular.[9:07.9]Thisisanadvancedexampleofcalcinosisuniversalisinapatientwithdermatomyositis.[9:14.4]Therearethicksheet-likecalcificationsthatareassociatednotonlywiththeshouldersandarms,butoverthethoraxaswell.[9:25.5]Calcificationsassociatedwithvascular[9:29.6]Vascularcalcificationsincludearterialcalcificationswhichprimarilyoccurinthewalls,[9:35.3]andvenouscalcificationswhichdonotoccurinthe[9:38.6]butoccurinsteadin asinphleboliths,in [9:48.6]Arterialcalcificationoccursinthe[9:52.5]Monckeberg'sarteriosclerosis(動脈中層硬化)isauniformwallcalcificationinwhichthemediaisinvolved.Monckeberg動脈硬化（動脈中層硬化癥）指累及動脈中層的均勻一[9:59.7]Ithasarailroad-trackappearance.Anddiabeticsaremuchmorepronetodevelopthisformofarterialcalcification.[10:07.5]Intimalatherosclerosistendstomuchmorediscontinuousandque-likeinitsform.[10:14.6]Thisisanexampleofthearterialtypeofcalcificationthatisseeninapatientwithdiabetes.[10:21.9]Monckeberg's[10:24.6]Youcanseethatthecalcificationisuniforminappearance.Andobviouslyyoucanseethereisasequelaofthediabetesitself.[10:32.6]Therehasbeenanabove-the-kneeamputation.(?)[10:36.7]This,ontheotherhand,isanexampleofthekindofdiscontinuouscalcification,inthisinstance,intheabdominalaorta,thatisusuallyseenwiththeintimalformofatherosclerosis.[10:52.5]Venouscalcificationsareusuallywithinsmallthrombi,phlebolith,whichhaveacharacteristiccentrallucency,orwithinlonger[11:03.4]Thisisanexampleofmultiplephlebolithinthe[11:06.8]Andyoucanseethatthisphlebolithhasacharacteristiccentrallucencywhichcanfrequentlyhelpdifferentiateitfromastoneintheurinarytract.[11:18.3]Thisisanexampleofalongcalcifiedvenous[11:23.0]Ithasashaggy,irregularappearance,butitislinearin[11:29.6]Andtherecanbecalcification,ossificationsecondarytochronicvenousdisease.[11:36.1]Thistendstobesubcutaneousandsheet-[11:39.3]Itoccursmostlyinpost-menopausal[11:42.6]Ithasapredilectionforthe[11:44.7]Andpathologically,thereisanormalbonethatisformedinasubcutaneouslocation.[11:51.8]Thisisanexampleofwhatchronicvenousinsufficiencylookslikeinthecalves.[11:56.7]You'llnoticethatthecalcificationisdiffuse.Itissheet-like.Anditinvolvestheentirecalf.[12:06.3]Myositis,orheterotopicossification,occursinthree[12:11.3]myositisossificanscongenitaprogressiva,whichisnowmoreoftencalledfibrodysiaossificansprogressiva,[12:21.0]myositisossificanssecondaryto[12:23.9]andmyositisossificanssecondarytoimmobilitywhichisnowmoreoftencalledheterotopicossification.[12:32.6]Fibrodysiaossificansprogressivaisageneticdyssiathatisautosomaldominant.[12:39.3]Itstartsusuallyintheneckandthenmoves[12:42.8]Italsomovesfromproximaltoperipheral.[12:46.5]Itinvolvesthebackandthenthewhole[12:50.0]Ossificationoccursintheconnectivetissuenotinmusclewhichiswhythenamewaschangedfrommyositistofibrodysia.[12:58.7]Anditdoesnotinvolveinfltionwhichisanotherwhythenamewas[13:04.0]Anditisalmostalwaysassociatedwithshortgreattoe,ashortthumb,orashortmiddlephalynxofthe5thfinger.[13:15.2]Thisisanexampleofmyositisossificans[13:19.4]inwhichtherearetheselargeclumpsofbonethatareseeninthispatientintheback.[13:28.7]Heterotopicossificationormyositisossificanssecondarytotrauma,isusuallylocalizedtothesiteofinjury.[13:36.5]Itoccursrapidlywithinthefirst4-6weeksafter[13:40.9]Itstartswithacloudorveilofcalcium,thenmaturestobone:thetrabeculae eevident,[13:47.8]andtheaxisforheterotopicossificationsecondarytotraumaalmostalwaystendstobeparalleltothemusclene,thatisparalleltothelongaxisofthebone。[13:58.5]Itisveryimportantthattheradiologistsrecognizeheterotopicossificationsecondarytotrauma,[14:04.4]becauseifit'sbiopsiedandsendtopathology,itmaybemistakenforan [14:13.8]Thisisanexampleofapatientwhosustainedtraumatothethightwoweeksbeforethisfirstradiographwasobtained.[14:22.6]Onweektwo,thesofttissuesarenormalin[14:26.7]Onweeksix,wecanbegintoseeathincloudorveilof[14:34.0]Andthenonweektwelve,weseedenseossificationwhichparallelsthelongaxisofthebone.[14:44.0]Heterotopicossificationsecondarytoimmobility,thecauseisnotknown.[14:49.4]Itoccursinpatientswhoareparalyzed,sometime