11.04-11.11 Radiographic patterns of disease

Question 1

What two conditions cause the “hair on End” reaction of the periosteum?

Answer 1

• Sickle cell anemia
• thalassemia
• the appearance has fine short striae that project upwards perpendicular to the surface of the skull

Question 2

what unit of measurement should be used for recording lesions?

Answer 2

-mm

Question 3

if you only see one lesion, what is the numerical distribution?

Answer 3

Solitary, focal,

-these lesions are usually small

Question 4

a ____ lesion refers to multiple lesions which have spread throughout a significant portion of the jawbone.

Answer 4

diffuse lesion

Question 5

lesions that are found in at least 3 quadrants of the jaws involving both the maxilla and the mandible

Answer 5

Generalized lesions

Question 6

bilateral symmetry frequently indicates..

Answer 6

a variant of normal or an inherited condition

Question 7

if you could draw a pencil line confidently around the edges of a lesion, you would describe the border as:

Answer 7

well-defined or distinct

Question 8

not only do you know where the lesion starts and stops, but there is further a radiopaque (white) line around the outside of the lesion, representing reactive bone. This is usually seen with ____ and ____ ____, and represents a subset of the well-defined border pattern

Answer 8

• Well-corticated, hyperostotic

- cysts and benign tumors

Question 9

punched out lesions and what conditions/diseases are associated with them?

Answer 9

very sharp boundary with no apparent reaction of the host bone to the presence of the lesion.
-commonly seen in multiple myeloma and Langerhan’s cell histiocytosis

Question 10

Multiple Myeloma and Langerhan’s cell histiocytosis are often associated with what type of radiographic lesions?

Answer 10

“punch out borders”

Question 11

the presence of a peripheral radiolucent rim around a radiopaque lesion indicates…

Answer 11

that the lesion has a soft tissue capsule and that it will likely shell out easily

Question 12

if you could not use a pencil to draw a line around the lesion and there is a zone of transition, the border would be defined as…

Answer 12

Ill-defined, poorly marginated

Question 13

the presence of ragged moth-eated borders indicates the presence of…

Answer 13

severe inflammatory disease or malignant neoplasia

-it can be the most aggressive, rapidly destructive pattern

Question 14

if the lesion is radiolucent, a circular shape, what is it most likely? and what is the “pattern?”

Answer 14

• characteristic of fluid filled cysts

- these are also referred to as a hydraulic pattern

Question 15

if the lesion undulates up and down along the roots of the teeth, what disorder is commonly associated with this and what type of lesion (RL or RO)?

Answer 15

only Radiolucent lesions

-commonly seen with simple bone cysts and odontogenic keratocysts (OKC)

Question 16

if the epicenter of a lesion is superior to the IAN canal, and especially if it is coronal to a tooth, the lesion is likely ____ in origin

Answer 16

odontogenic, if it’s below it’s non-odontogenic

Question 17

if a lesion arises in the IAN canal, it is comprised of ___, ____ or ______ ____ elements

Answer 17

neural, vascular or smooth muscle elements

Question 18

lesions in the condyle may be ____ in nature

Answer 18

cartilaginous

Question 19

central lesions arise in…

Answer 19

the cancellous bone of the jaw, with cortex on either side and alveolar bone superiorly

Question 20

peripheral lesions arise at the …

Answer 20

alveolar creast. Saucerization with a wide zone of transitions between obviously normal and abnormal bone is a sign of carcinoma

Question 21

localized enlargement of crestal bone is an ominous sign, which may be the only sign of …

Answer 21

an osteosarcoma or chondrosarcoma

Question 22

periosteal lesions

Answer 22

arise in the periosteal compartment of bone,

Question 23

when can periosteal lesions be visualized the earliest?

Answer 23

on occlusal radiographs

Question 24

circumcoronal RL

Answer 24

can develop from REE (dentigerous cyst) or represent infiltration of the follicular space by another lesion (ie OKC)

Question 25

periapical lesions usually represent

Answer 25

osteolysis resulting from products of inflammation exuding from a devitalized tooth

Question 26

architecture refers to which type of lesions?

Answer 26

radiolucencies

Question 27

Multilocular Radiolucency: honeycomb

Answer 27

usually indicates the presence of ameloblastoma and sometimes an intraosseous hemangioma

Question 28

ML RL: tennis racket

Answer 28

septae are aligned at right angles, seen exclusively in ODONTOGENIC MYXOMA

Question 29

odontogenic myxoma will show what radiographic pattern?

Answer 29

tennis racket

Question 30

texture is used to describe what type of lesions?

Answer 30

radiopacities

Question 31

different types of textures

Answer 31

• homogeneous
• multilobulated
• ground glass
• orange peel
• cotton wool

Question 32

ground glass texture suggests what condition?

Answer 32

fibrous dysplasia

Question 33

orange peel texture is characteristic of what condition?

Answer 33

late stages of fibrous dysplasia

Question 34

cotton wool texture

Answer 34

could be condensing osteitis (local) or widespread, pagets disease

Question 35

different descriptions for the densities of lesions include

Answer 35

• RO, RL
• RL with RO flecks (foci)
• mixed RL/RO

Question 36

different effects that lesions can have on adjacent teeth

Answer 36

• root divergence
• tooth “floating in air”
• root resorption by blunt pressure
• circumferential root resorption

Question 37

what can cause circumferential root resorption?

Answer 37

malignant neoplasms or very aggressive lesions

Question 38

effects of lesions on bone

Answer 38

• cortical expansion
• cortical perforation
• periosteal reactions (onion skinning, sunburst spiculation,hair on end)

Question 39

cortical expansions is usually the result of what type of lesions?

Answer 39

-benign lesions be they grow slowly allowing the periosteum to lay down new bone so perforation does not occur

Question 40

Periosteal rxn, Onion skinning: what causes the appearance and what conditions are associated with it?

Answer 40

the periosteum is irritated and lays down multiple layers of new periosteal bone.
-seen in inflammatory conditions (proliferative periostitis) and neoplasms (Ewing’s sarcoma)

Question 41

Ewing’s sarcoma will give what radiographic appearance?

Answer 41

-periosteal rxn, onion skinning

Question 42

periosteal rxn: sunburst spiculation, how does it occur?

Answer 42

malignant tumors grow so rapidly that they perforate out the cortex into the soft tissues, dragging new striae of bone which was being formed