致谢:该病例来自auntminnie Board Review——Musculoskeletal
翻译:赵文韬 江门市中心医院 放射科
A 54-year-old woman presents with knee pain.
What abnormality is depicted in the images?
A. Joint effusion
B. Joint effusion and synovitis
C. Hemarthrosis
D. Lipohemarthrosis
在图片中描述了什么异常?
A. 关节积液
B. 关节积液和滑膜炎
C. 关节炎
D. 积脂血症
Correct answer : D
Explanation: There is joint effusion in the suprapatellar pouch with hypo- and hyperdense components. Fat (hypodense) floats on blood/effusion because it is less dense, showing a fat-fluid level.
正确答案:D
解释:髌上囊内有关节积液,伴有低密度和高密度成分。低密度的脂肪漂浮在血液或者渗出液上,因为它密度较低,显示出脂肪液水平。
Based on the pertinent imaging feature depicted on these images, what underlying pathology should be suspected?
A. Intra-articular fracture
B. Extra-articular fracture
C. Patellar dislocation
D. Bleeding diathesis
根据图像的这些相关影像特征,应该怀疑哪些潜在的病理基础?
A.关节内骨折
B.关节外骨折
C.髌骨脱位
D.出血
Correct answer : A
Explanation:
The presence of lipohemarthrosis indicates there is an intra-articular fracture because fat escapes from bone marrow into the joint space. It is commonly seen in knee fractures, particularly tibial plateau fractures or distal femoral fractures. Lipohemarthrosis can be noted on radiography, and if seen without a radiographically obvious fracture, it is the radiologist's job to point to out to the referring clinician that there is likely a radiographically occult intra-articular fracture and CT should be performed for further clarification.
正确答案:A
解释:积脂血症的出现表明这是一种关节内骨折,原因是脂肪从骨髓溢出进入关节间隙。常见于膝关节骨折,尤其是胫骨平台或股骨远端的骨折。积脂血症可被放射学检查发现。但如果没有明显的骨折,放射科医生应向申请检查的临床医生提示可能有隐匿性关节内骨折,应进行CT检查以进一步明确。
关节积脂血症:又称关节积脂血病、脂肪血性关节炎等,多见于严重的骨关节外伤,尤其是关节内骨折,以四肢大关节多见,最常见于膝关节和肩关节,其次是髋关节和踝关节。当发生关节内骨折后,从骨髓腔或撕裂的骨膜处溢出的脂肪组织和血液同时进入关节腔内。因血液密度相对较大,沉于关节液之下,而脂肪密度相对小,漂浮于关节液之上,从而形成分层现象,即影像上所说的脂肪-血液界面征(fat-blood interface sign, FBI sign)。
MRI是显示关节积脂血症的最佳影像方法。在MRI上,脂肪呈高T1、稍高T2信号,血液为(稍低T1、稍高T2信号,两者之间常可见到明显的液液界面。有时中间还可见低T1高T2信号的关节液层。在不同时期血液中的成分不同,MRI可以呈现为不同的信号。随着患者体位的改变,关节腔内的液一液平面亦会发生相应的改变,但高信号的脂肪层始终位于最上方。
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