30. Bone Radiology Flashcards
Swelling centered at the joint indicates what kind of arthritis?
reflects synovial inflammation or injury (ex, RA)
what type of arthritis?
RA
soft tissue swelling, centered at joints
what condition?
gout
soft tissue is lumpy-bumpy
focal collections of urate crystals by joints
what condition?
psoriatic arthritis
joints thickened in a uniform way (sausage digits)
what condition? what is notable?
RA
demineralization/juxta-articular osteoporisis
demineralization in and around joints
(of limited usefulness diagnostically)
condition?
psoriatic arthritis
increased density (dense-looking phalynges) due to abnormal repair processes.
(“Ivory digit”)
joint space narrowing indicates what?
reflects the loss of articular cartilage
if there is uniform joint space narrowing, what should I be thinking?
uniform reflects diffuse/uniform loss of articular cartilage.
think inflammation: RA, septic arthritis, psoriatic, reactive
what cytokines are inside the joint that cause narrowing?
IL6, IL1, metalloproteases
uniform narrowing in inflammatory processes because the same “soup” covers the entire joint
condition?
RA
reflects uniform joint space narrowing.
IMPT SLIDE
if I see non-uniform joint space narrowing, what types of conditions should I be thinking about?
degenerative diseases: osteoarthrosis, pseudo-gout (CPPD)
(more focal processes than the inflammatory conditions)
condition? notable?
non-uniform joint space narrowing.
Osteoarthritis
what is the most frequently affected part of the knee joint with osteoarthritis?
will the patient be varus or valgus?
most frequently medial compartment narrowing with OA
varus (bow-legged, like there’s a horse btwn their legs)
which is RA, which is OA?
Left: RA (uniform joint narrowing, demineralized bone)
Right: OA (non-uniform joint narrowing)
in what arthritic-like conditions is joint space preserved?
how is this possible?
gout, pigmented villonodular synotivis, “early” OA
the joint is preserved because damage is very focal
define Marginal Erosions.
occurs in what conditions?
destruction of “uncovered” bone by the inflammatory pannus
think RA, psoriatic, reactive
(pic is labeled RA in slides, though it looks a lot like gout to me…..)
- Jen - I looked it up. RA may present very similiarly to Gout but the key difference is that RA has a uniformly narrowed joint space, whereas gout has a preserved joint space (since it does focal damage to the joint). Therefore in this joint, you see that the joint space is narrowed!) Hope this helps..Also you may see a lighter rim bordering the erosion, which is indicative of reactive new bone growing.
condition?
Gout.
note erosions, which are well-defined and may be remote from the joint.
Note also overhanging edge of bone (due to bone having a chance to partially repair)
what is sublexation?
what condition will have sublexation with bony erosions?
sublexation without bony erosions?
incomplete or partial dislocation due to laxity or disruption of ligamentous support.
sublex WITH erosions = RA
sublex WITHOUT erosions = SLE
(super high yield)
this is sublexation without erosions, therefore the condition is….?
lupus
this is sublexation with erosions, therefore the condition is….?
RA
what are osteophytes? what condition do they occur in?
endochondral bone formation that extends the articular surface. at point of injury of the articular cartilage
classic for OA
condition? finding?
osteoarthritis
DIP osteophytes
condition? finding?
swelling around the joint, “fluffy” bone which indicates proliferative bone.
Psoriatic arthritis.
Pic: did someone xray a penis? nope. proliferative bone haha. think psoriatic arthritis
what is ankylosis?
in what conditions does it occur?
in what condition do you see ankylosis in carpal and tarsal bones but no where else?
fusion of bone due to joint destruction and inflammation
typical for seronegative spondylitis
in RA, see ankylosis only in carpal and tarsal bones. (HIGH YIELD)
Pic: psoriatic arthritis with ankylosos of IP (big toe)
what’s this?
ankylosing spondylitis.
spine looks like a single line. due to fibrosis, edge of discs have ossified. eventually becomes tubular and remodels over time
what is DISH?
how is it different from ankylosing spondylitis?
DISH = Diffuse Idiopathic Skeletal Hyperostosis. subset of ank spond: the ossification is in the anterior or posterior longitudinal ligament rather than annular ligament (AS).
DISH has a thick, irregular appearance on imaging
condition? notable?
overhanging edge of gout.
bone extnding beyone the margin of bone: reactive bone that is adjacent to tophus.
bone trying to grow around the deposit of tophus almost as if it is a foreign body
condition?
calcification.
characteristic of scleroderma
What is the joint distribution of:
Gout?
OA?
RA?
Gout: 1st MTP
OA: DIP, 1st CMC (base of thumb)
RA: MCP and MTP
HIGH YIELD
Practice Q: what is this?
Rheumatoid Arth
Soft tissue swelling is centered at joint. Uniform loss of joint space/cartilage
Joints affected: MCP, PIP
Practice Q: what is this?
Psoriatic Arthritis
Preserved bone density
soft tissue swelling (yellow arrow)
Marginal erosions (orange arrows)
periostitis (green arrow)
Practice Q: what is this?
Gout
lumpy bumpy soft tissue swelling, MTP joint involved
well-defined erosion (orange arrow)
Practice Q: what is this?
Osteoarthritis
Nonuniform narrowing of joint
Subchondral sclerosis
Involvement of hip and knee
