Ï8b´Yb*8Yt8cÉOÀÎÀ¶½U½¸~sÀ¡ ARTÍCULO ORIGINAL 'U/XLV-DLU6iQFKH]7RUUHV 'UD0DULFHOD6DQWRV+HUQiQGH] Descripción del signo radiológico del hueso fantasma y revisión de otros hallazgos relacionados RESUMEN Introducción $GHPiV GH OD DXVFXOWDFLyQ FOtQLFD GH ORV SDFLHQWHV OD UDGLRORJtD FRQvencional es el instrumento de JDELQHWHPiV~WLOHQHOGLDJQyVWLFR GLIHUHQFLDO GH ODV OHVLRQHV HVTXHOpWLFDV Objetivo: GHVFULELU XQ VLJQR UDGLROyJLFR DO TXH KHPRV denominado signo del hueso fantasma DVt FRPR KDFHU XQD UHYLVLyQGHORVGLIHUHQWHVKDOOD]JRVUDGLROyJLFRVHQFRQWUDGRVHQ SDWRORJtDyVHDUHODFLRQDGD Material y métodos 'HVFULELU \ SURSRUFLRQDU HO VLJQL¿FDGRFOtQLFRGHOKDOOD]JR\VXV GLIHUHQWHV YDULHGDGHV SDUD SRVWHULRUPHQWHUHODFLRQDUORFRQ ODSUiFWLFDPpGLFDPHGLDQWHOD REVHUYDFLyQGHLPiJHQHVUDGLROyJLFDVUHSUHVHQWDWLYDV Resultados (O signo del hueso fantasma consiste en XQDSpUGLGDyVHDTXHVHSURduce a consecuencia de proFHVRVQHRSOiVLFRVLQIHFFLRVRV o de intolerancia a elementos H[WHUQRV LPSODQWDGRV HQ HO SDFLHQWH 6HUYLFLRGH&LUXJtDGH&DGHUD\3HOYLV 'HSDUWDPHQWRGH5DGLRORJtDH,PDJHQ 8QLGDG0pGLFDGH$OWD(VSHFLDOLGDG+RVSLWDOGH7UDXPDWRORJtD\2UWRSHGLD1R &HQWUR0pGLFRGHO1DFLRQDOGHO1RUHVWH,QVWLWXWR0H[LFDQRGHO6HJXUR6RFLDO0RQWHUUH\1XHYR /HyQ0p[LFR+HUPHQHJLOGR*DOHDQDHVTXLQDFRQ,VDDF*DU]D&HQWUR0RQWHUUH\1/ &RUUHVSRQGHQFLD'U/XLV-DLU6iQFKH]7RUUHV&RUUHRHOHFWUyQLFRRQFRRUWR#D[WHOQHW /DUDGLRORJtDFRQYHQFLRQDOKDVLGRGHVGHVXDSDULFLyQHQ1HOPpWRGRGHHOHFFLyQHQHOGLDJQyVWLFR GLIHUHQFLDOGHODVDIHFFLRQHVHVTXHOpWLFDV(OREMHWLYR principal del presente trabajo consiste en dar a conocer \ KDFHU OD GHVFULSFLyQ GH ODV FDUDFWHUtVWLFDV SURSLDV GHXQKDOOD]JRUDGLROyJLFRDOTXHKHPRVGHQRPLQDGR ³VLJQRGHOKXHVRIDQWDVPD´phantom bone signDVt FRPRSURSRUFLRQDUVXWUDGXFFLyQRVLJQL¿FDGRFOtQLFR (OREMHWLYRVHFXQGDULRHVKDFHUXQDUHFRSLODFLyQ\UHYLVLyQHQODOLWHUDWXUDPXQGLDOGHORVGLIHUHQWHVVLJQRV HLPiJHQHVUDGLROyJLFDVFRQYHQFLRQDOHVHQFRQWUDGRV HQODSDWRORJtDUHODFLRQDGDHVGHFLUHQFRQGLFLRQHV QHRSOiVLFDVHLQIHFFLRVDVGHOHVTXHOHWR Signo radiológico del hueso fantasma (VWHVLJQRFRQVLVWHHQODSpUGLGDGHXQDRPiV]RQDVGHXQVHJPHQWRyVHRHQSDFLHQWHVTXHSXHGHQR 1 3 6 Julio-Septiembre 2012 Conclusión /D UDGLRORJtD FRQYHQFLRQDOVLJXHVLHQGRXQD KHUUDPLHQWDPX\LPSRUWDQWHHQ HOGLDJQyVWLFRGHODVGLIHUHQWHV DIHFFLRQHV yVHDV &RQRFHU HO signo del hueso fantasma puede D\XGDUQRV D KDFHU PHMRUHV GLDJQyVWLFRV GLIHUHQFLDOHV VLHPSUHDSR\DGRVSRUODFOtQLFD Palabras clave: UDGLRORJtD FRQYHQFLRQDO VLJQR GHO KXHVR IDQWDVPD Continúa en la pág. 137 QRFRQWDUFRQDQWHFHGHQWHVFOtQLFRVUHODFLRQDEOHVFRQ DIHFFLyQDOJXQDHQOD]RQDGDxDGD/DSpUGLGDGHOD PDWHULDyVHDJHQHUDOPHQWHVHVXVWLWX\HSRUXQDVRPEUD FUHDGDSRUHOSURFHVRGHRULJHQHQODVSDUWHVEODQGDV FLUFXQGDQWHV6LHODVSHFWRFOtQLFRGHOSDFLHQWHDVtOR VXJLHUHHVGHFLUFXDQGRSRUODLQIRUPDFLyQUHFRSLODGD WDQWRSRUHOLQWHUURJDWRULRFRPRSRUODH[SORUDFLyQItVLFD VHFRQVLGHUDFRPRSRVLELOLGDGGLDJQyVWLFDXQSURFHVR QHRSOiVLFR R LQIHFFLRVR VLQ LQWHUYHQFLyQ WHUDSpXWLFD SUHYLD HQ OD ]RQD UDGLROyJLFDPHQWH GDxDGD VH HVWi KDEODQGRGHXQ³VLJQRGHOKXHVRIDQWDVPD de novo´ LPiJHQHV $O SDFLHQWH QR VH OH FRQRFH FRPR SRUWDGRU GH OD HQIHUPHGDG HQ FXHVWLyQ R DO PHQRV QR HQ HO VHJPHQWR yVHR UHIHULGR KD\ TXH UHFRUGDU TXHDOJXQRVSDGHFLPLHQWRVFRPRODHQIHUPHGDGyVHD PHWDVWiVLFDRHOPLHORPDP~OWLSOHSXHGHQFXUVDUFRQ SURFHVRV SROLRVWyWLFRV TXH SXHGHQ GHVDUUROODUVH GH PDQHUDVLQFUyQLFDRPHWDFUyQLFD 2WUD SRVLELOLGDG SDUD TXH VH SUHVHQWH HVWH VLJQR UDGLROyJLFR VRQ ORV SDFLHQWHV YLJLODGRV WUDWDGRV R LQWHUYHQLGRV SUHYLDPHQWH HQ XQ VHJPHQWR yVHR DIHFWDGRSHURHQORVTXHFRQHOSDVDUGHOWLHPSRYD Viene de la pág. 136 ABSTRACT Introduction ,Q DGGLWLRQ WR FOLQLFDOH[DPLQDWLRQRISDWLHQWV FRQYHQWLRQDO UDGLRORJ\ LV WKH PRVWXVHIXOFOLQLFDOLQVWUXPHQWLQ GLIIHUHQWLDOGLDJQRVLVRIVNHOHWDO LQMXULHV Objective: describe a radioloJLFDOVLJQZKLFKZHKDYHQDPHG phantom bone signDQGUHYLHZ WKHGLIIHUHQWUDGLRORJLFDO¿QGLQJV encountered in related bone SDWKRORJ\ Material and methods 'HVFULEH DQG VWDWH WKH FOLQLFDO PHDQLQJ RI WKH ¿QGLQJ DQG LWV GLIIHUHQWYDULHWLHVWRWKHQUHODWH LW WR PHGLFDO SUDFWLFH WKURXJK REVHUYDWLRQ RI UHSUHVHQWDWLYH UDGLRORJLFDOLPDJHV Results7KHphantom bone sign FRQVLVWV RI ERQH ORVV RFFXUULQJDVDUHVXOWRIQHRSODVWLF RU LQIHFWLRXV SURFHVVHV RU LQ- GHVDSDUHFLHQGR GLFKR VHJPHQWR HVTXHOpWLFR GHELGR DVXUHHPSOD]RSRUSHUVLVWHQFLDRSRUUHFXUUHQFLDGH ODDFWLYLGDGQHRSOiVLFDRELHQSRUGHVWUXFFLyQDEVRUFLyQ yVHD GHELGD D SURFHVRV LQÀDPDWRULRV R GHELGR DLQWROHUDQFLDDHOHPHQWRVH[WHUQRVLPSODQWDGRV(Q HVWRV FDVRV JHQHUDOPHQWH VH KDFH DSDUHQWH HQ ODV UDGLRJUDItDVFRQYHQFLRQDOHVODH[LVWHQFLDGHPDWHULDO GH RVWHRVtQWHVLV SUyWHVLV R FHPHQWR TXLU~UJLFR VLQ TXHHVWRVHDXQDFRQGLFLyQsine qua nonHQDXVHQFLDGHKXHVRHQFLHUWDV]RQDVLPDJHQ%DMRHVWDV FRQGLFLRQHVGHQRPLQDPRVDOKDOOD]JRsigno del hueso fantasma evidente\DTXHHQHVWRVSDFLHQWHVVHFXHQWD FRQODHYLGHQFLDUDGLROyJLFDGHTXHSUHYLDPHQWHHV GHFLUHQHWDSDVPiVWHPSUDQDVGHOSDGHFLPLHQWRHQ YLJLODQFLDRWUDWDPLHQWRHVWDEDSUHVHQWHHOVHJPHQWR yVHR TXH SRVWHULRUPHQWH KD GHMDGR GH HYLGHQFLDUVH LPiJHQHV\ (QDPERVFDVRVODLQH[LVWHQFLDyVHDGHEHPHGLUDO PHQRVFHQWtPHWURVGHGLiPHWURGHSUHIHUHQFLDGHEH REVHUYDUVHODVRPEUDUDGLROyJLFDXRSDFLGDGFUHDGDSRU XQDPDVDGHSDUWHVEODQGDVRHQVXGHIHFWRSRUXQD FROHFFLyQVXVWLWX\HQGRDVtRFLUFXQGDQGRDOGHIHFWR FUHDGRORVPiUJHQHVGHGLFKDOHVLyQQRVXHOHQHVWDU OLPLWDGRVSRUKDORHVFOHURVRUHDFWLYRVDOYRHQSURFHVRV FUyQLFRVRGHEDMRJUDGRGHDJUHVLYLGDGHQFX\RFDVR ODH[LVWHQFLDGHGLFKRKXHVRHVFOHURVRSXHGHVHUPiV DEXQGDQWH \ GLIXVD VLHQGR PiV SUREDEOH HQ HVWDV FLUFXQVWDQFLDVTXHHORULJHQVHDGHtQGROHLQIHFFLRVD DEVFHVR\QRQHRSOiVLFRsigno del hueso fantasma infecciosoVLQTXHHVWRVHDXQDUHJOD(VWDVLWXDFLyQ WDPELpQSXHGHSUHVHQWDUVHHQOHVLRQHVQHRSOiVLFDVGH EDMRJUDGRGHPDOLJQLGDGHQ]RQDVDQDWyPLFDVFRPR ODSHOYLVGRQGHHOWDPDxRGHODOHVLyQSXHGHDOFDQ]DU JUDQGHVGLPHQVLRQHVDQWHVGHTXHRFDVLRQHVtQWRPDV \ HQ FRQVHFXHQFLD VH SXHGD KDFHU XQ GLDJQyVWLFR FOtQLFR\UDGLROyJLFR/DVOHVLRQHVVLQKDORHVFOHURVR JHQHUDOPHQWHQRFXUVDQFRQPiUJHQHVELHQGH¿QLGRV WROHUDQFH WR H[WHUQDO HOHPHQWV LPSODQWHGLQWKHSDWLHQW Conclusion &RQYHQWLRQDO UDGLRORJ\UHPDLQVDYHU\LPSRUWDQW WRROLQGLDJQRVLQJGLIIHUHQWERQH FRQGLWLRQV 8QGHUVWDQGLQJ WKH phantom bone sign may KHOS XV PDNH EHWWHU GLIIHUHQWLDO GLDJQRVHVDOZD\VVXSSRUWHGE\ FOLQLFDO¿QGLQJV Key words: conventional UDGLRORJ\SKDQWRPERQHVLJQ WDO \ FRPR VXFHGH HQ ODV LPiJHQHV HQ VDFDERFDGR IUHFXHQWHPHQWH REVHUYDGDV HQ HO PLHORPD P~OWLSOH PiV ELHQ HQFRQWUDPRV TXH OD ]RQD GH WUDQVLFLyQ HV DPSOLD\HVWiFRQIRUPDGDSRUXQSDWUyQGHGHVWUXFFLyQ SHUPHDWLYRRELHQDSROLOODGR(QDOJXQRVFDVRVSXHGH KDFHUVH SUHVHQWH KXHVR UHDFWLYR GH QHRIRUPDFLyQ WUDWDQGRGHGHOLPLWDURFRQWHQHUDODPDVDQHRSOiVLFD JHQHUDGDRHQWpUPLQRVJHQHUDOHVDOSURFHVRTXHOH KDGDGRRULJHQ (QFXDOTXLHUDGHVXVYDULHGDGHVHVWHVLJQRUDGLROyJLFR SXHGH SUHVHQWDUVH HQ ]RQD DUWLFXODU R FRQ OD DIHFFLyQHQGRVKXHVRVYHFLQRVLPDJHQ (O VLJQLILFDGR GH HVWH KDOOD]JR HV OD H[LVWHQFLD signo del hueso fantasma GHQRYRRHQVXGHIHFWROD SHUVLVWHQFLDRUHFXUUHQFLDsigno del hueso fantasma evidente GH HQIHUPHGDG QHRSOiVLFD HVTXHOpWLFD HV GHFLU HQIHUPHGDG DFWLYD (O SURFHVR QHRSOiVLFR KD DIHFWDGR DO VHJPHQWR yVHR GH WDO PDQHUD TXH OR KD UHHPSOD]DGRSRUPDVDWXPRUDOGHPRVWUDEOHPHGLDQWH 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