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1
Q

Generalised inc bone density

12

A

Mets
SCD
Myelofibrosis

renal osteodystrophy
osteopetrosis
pagets
mastocytosis

Fluorosis
pyknodysostosis
hypopara 10%
prog diaphyseal dysplasia ( camurati)
Myeloma POEMS
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2
Q

Solitary sclerotic bone lesion

15

A 
bone island
enchondroma
mets
callus
bone infarct
pagets
osteoma
OO/osteoblastoma
healed lesion - mets ets
primary bone sarcoma
FD
chronic osteomyelitis
CRMO
Lymphoma
cement/bone graft
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3
Q

Multiple sclerotic bone lesions

16

A

Mets
multiple healed bone lesions
pagets- poly

bone infarcts
stress fractures
lymphoma
osteopoikilosis
multifocal osteosarc
multiple osteomas
FD
CRMO/SAPHO
osteopathia striata
erdheim chester-metadiap
myeloma 3%
TS
intramedullary osteosclerosis
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4
Q

Bone sclerosis with a periosteal reaction

13

A 
healing fracture
mets
OO/osteoblast
chronic ostemyeltis
osteosarcoma
Ewings
chondrosarcoma
lymphoma
CRMO/SAPHO
Infantile cortical hyperostosis - <6m, mand,ribs,clav

melerheostosis
tertiary syphilis

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5
Q

Solitary sclerotic bone lesion with a lucent centre

9

A

OO/osteoblast
brodies
medullary bone infarct
stress fracture

loosers zone
liposclerosis myxofibrous tumour
TB

Syphilis
Yaws :papillomas, t pallidum pertunue

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6
Q

Coarse trabecular pattern

6

A 
pagets
osteoporosis
ostemalacia
haemoglobinopathies
haemangioma
Gauchers
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7
Q

Lytic skeletal metastases

5

A 
Lung
Breast
myeloma
non mucinous adeno GI
most other primary
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8
Q

Lytic expansile skeletal mets

5

A 
RCC
thyroid
HCC
melanoma
phaeo
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9
Q

Sclerotic skeletal mets

7

A 
Breast
Prostate
Mucinous adeno GI
TCC
carcinoid
small cell lung
lymphoma - rare
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10
Q

Mixed skeletal mets

8

A 
breast
lung
lymphoma
cervix
testis
TCC
melanoma
neuroblastoma paeds
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11
Q

lucent bone lesion with welldefined sclerotic margin 1A

12

A 
NOF, BFH (>25)
SBC/ABC
FD
chondroblastoma/Clear cell chondrosarc >20yrs
Brodies
Healings mets/primary
Osteoblastoma
IO lipoma
Liposclerosisng myxo
adamantinoma/OFD
CMF
haemophilic pseudotumour
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12
Q

Lucent bone lesion
well defined non sclerotic margins 1B

9

A 
Mets
myeloma/plasma
low grade chondral lesions
GCT
SBC/ABC
EG
Browns
lytic phase pagets
desmoplastic fibroma
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13
Q

Lucent bone lesions
poorly defined margins
1C
7

A 
mets
myeloma
osteomyelitis
bone lymphoma
primary bone sarcomas
EG < 30yrs
GCT - 20-50yrs
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14
Q

Grossly expansile lucent bone lesion

12

A 
plasmacytoma
mets
ABC
GCT
telangiectatic osteosarc
FD- fusiform
Browns
Haemangioma
Chordoma
Haemophilic
slow growing central sarcoma
Hydatid
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15
Q

Lucent epiphyseal bone lesion

7

A

related to jt path - geode,ganglion,erosion,ocd, pvns

GCT
chondroblastoma
Infection - brodies
clear cell chondrosarcoma
location sp - IO lipoma, SBC, osteoblastoma
lesions that occur anywhere-mets,browns,lymph,myelo,haemo

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16
Q

Lucent bone lesions with calcium or bone

A 
enchondroma
OO/osteoblastoma
AVN/bone infarction
mets
chondroblastoma
chondrosarcoma
osteosarc
FD
ostemyelitis
EG
IO lipoma
haemangioma
liposclerosis
UPS/fibrosarc
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17
Q

exophytic/juxta cortical bone lesions

A

callus
osteochondroma
heterotopic ossif/myositis ossificans
surface osteosarc : paros, perios, high grade

Perisoteal chondroma/chondrosarc

cortical desmoid

parosteal lipoma-bony excresece

BPOP - perios hands

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18
Q

moth eaten bone

8

A 
mets
MM
sarcomas
lymphomas
LCH
OM
osteoporosis
hyperparathyroidism
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19
Q

Regional osteopenia

8

A 
disuse
CRPS
inflamm arthropathy
septic
transient osteoporiss
reginal migratory osteo
haemophilic arthro
soft tissue AVM
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20
Q

Gen osteopaenia

4

A

osteoprosis
diffuse iniltrative bone disease eg MM
osteomala/rickets
hyperparathyroidism

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21
Q

osteoporosis causes
primary 3
secondary 6

A

postmenopausal
age related
juvenile 8-12

endocrina
disuse
iatrogenic
deficiency states
chronic disease
congenital
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22
Q

osteomal/rickets
causes
5

A 
Vit D deficiency
renal disease: glom/tubular
hepatic disease
anticonvulsants: pheno/pheno
tumour assoc - benign phosphaturic tumour
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23
Q

osteomalacia/rickets
<6 months

4

A

biliary atresia
metabolic bone disease of prematurtiy
hypophosphatasia
Vit D dependent rickets

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24
Q

periosteal reaction parallel spiculated hair on end

3

A

Ewings
Caffeys
Syphilis

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25
Q

periosteal reaction divergent spiculated

7

A 
Osteosarc
mets
ewings
haemangioma
meningioma
TB
tropical ulcer
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26
Q

codman triangle

2

A

aggressive bone tumour

osteomyelitis

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27
Q

periosteal reaction solitary and localised

4

A

Trauma
insuff/stress #
inflammatory
neoplastic : malig/benign + #

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28
Q

periosteal reaction
BL symmetrical
6

A 
HPOA
vascular insufficiency - venous
thyroid acropachy
Pachydermoperiostitis
fluorosis
hypervitaminosis A
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29
Q

periosteal reaction
BL asymm
8

A 
mets
osteomyelitis
reactive/psoriatic
NAI
osteoporosis
osteomalacia
bleeding diathesis
sickle cell dactylitis
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30
Q

secondary HPOA
causes 23

lung 9
GI 7
cardiac 1
other malignancy 6

A 
LUNG:
lung carcinoma >60%
bronchiectasis
lung mets
pleural fibroma
mesothelioma
pulmonary fibrosis
sarcoidosis
chronic lung infection
pulmonary AVM
GI:
IBS
coeliac
Whipples
polyposis
malignancy
cirrhosis
HB malignancy

Cardiac - cyanotic CHD

other malignancy:
lymphoma, NPC, RCC, phyllodes, thymic ca, melanoma

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31
Q

XS callus formation

8

A

hypertrophic fracture non union
neuropathic arthropathy
steroid/cushings

Osteogenesis
paralysis
renal osteodystrophy
MM
NAI
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32
Q

AVN causes

13

A 
corticosteroids
alcohol
idiopathic - perthes
fractures
chemotherapy
haemoglobinopathies - SCD
radiotherapy
metabolic/endocrine
CTD/CVD
Toxins - nsaid, immuno
haemopoetic disorders
thrombotic/embolic
Others : pancreat, burns, amyloid
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33
Q

erosion of medial metaphysis of humerus

6

A 
normal
chronic rotator cuff tear
hyperpara
RA
malignancy
lysosomal storage disorder
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34
Q

erosion/absence outer end of clavicle

10

A

post traumatic
post op
RA

malignancy
septic
hyperpara
cleidocranial dysplasia
pyknodysostosis
scleroderma
gour
35
Q

Madelung
causes
5

A 
Growth arrest -injury/infection
multiple hereditary exostoses
Turner :+ lunatotriq coa
achondroplasia
leri Weill dyschondroseosis
36
Q

most common isolated carpal fusion

A

lunato-triquetral 1%

37
Q

acquired carpal fusion

5

A 
inflammatory arthritis - JIA/RA
pyogenic arthritis
chronic TB
post traumatic
post surgical
38
Q

short MC/MT

5

A 
idiopathic
post traumatic
post infarction
turner
pseudo and pseudopseudohypo
39
Q

Acro osteolysis

11

A 
scleroderma
raynaud
psoriatic
hyperpara
Trauma
peripheral neuropathy
Other arthritis : FIA,Reactive, multicentric
Other skin : dermato, epidermy
phenytoin toxicity
snake/scorpion venom
pyknodysosto - mimic
40
Q

distal phalangeal destruction - resorption of midportion

A

hyperpara
PVC cleaners
Hadju Cheney

41
Q

lytic lesions of phalanges

7

A

osteomyelitis
mets - lung mc

enchondroma
joint based
implant dermoid
glomus
sarcoid
other rare : fd, abc,gct,sbc,brown, lch
42
Q

F-F levels in bone lesions

A 
ABC
chondroblastoma
GCT
SBC
FD

telangiectatic osteosarc
any necrotic bone tumour

43
Q

pharyngeal mucosal space lesions
Nasopharynx
6

A 
NPC - post LN, mets 20%, petct
Lymphoma : NHL
Lymphoid hyperplasia : tiger stripe CE
Tornwaldt cyst - ML
Juvenile angiofibroma
minor salivary gland malignancy
44
Q

pharyngeal mucosal space lesions
Oropharynx
5

A

Tonsil SCC- II/III LN, HPV

Palatine tonsil inflamm/abscess

Lymphoma : NHL, waldeyers

Minor salivary gland malig

Crohns : rare

45
Q

Masticator space lesions

7

A

Abscess

Bony lesions of mandible

Incidental benign conditions :
masticator muscle hypertrophy (>1.5cm)
incidental small masticator muscles
pterygoid venous plexus asymmetry

Motor denervation CN VII : acute,SA, chronic

Sarcoma

Perineural tumour extension : SCC, mela, sarc, NHL, ad cystic parotid

Schwannoma V

46
Q

Focal parotid space lesions

5

A

Pleomorphic adenoma: hypoec, post enh, homogeneous +/- Ca, T2 low rim, myxoid types

Warthins : tail, B/L 20%, 6th decade,, smokers, hetero, cystic change, hypervascular, no Ca, mural nodule suggestive, minmal CE

Nodal mets

Salivary gland carcinomas : mucoepi, adenoid cystic, ill defined, T2 low, perineural sp

First branchial cleft cyst

47
Q

Diffuse parotid enlargement

5

A

PArotitis

Sjogrens : look MALT lym, other glands involved cf HIV

Benign lymphoepithelial lesions HIV : reactive adeno

Sarcoidosis : mimics sjogrens, no nhl risk, medisat LN

Lymphoma : NHL systemic

48
Q

Carotid space lesions

6

A

Carotid body paraganglioma: check Xd :MEN,carney,NF,vHL
salt pepper appearnce

Vagal Schwannoma :

Jugular vein thrombosis : see Lemierre Xd

Glomus vagale : 2cm below skull base, ICA ant, IJV post

Pseudoaneurysm

Neurofibroma

49
Q

Pre vertebral space lesions

5

A

Vertebral body mets

Infection

Schwannoma check neural foramen

Chordoma - rare in CS

Plexiform NF

50
Q

Posterior cervical space lesions

6

A

Lymphadenopathy

Third branchial cleft cyst : posterolateral to cartoid space

Nerve sheath tumour

Nodular fasciitis: SC, muscular fascia

Thoracic duct cyst - Left SC fossa

Venous diverticulum : IJV:SC

51
Q

Focal retropharyngeal space lesions

6

A

Reactive LN
Metastatic LN
Lypmhoma

MNG

Ectopic parathyroid adenoma

Schwannoma

52
Q

Diffuse retropharyngeal space lesions

5

A

Abscess

Effusion

Suppurative adenopathy

Longus colli tendonitis:C1-2, calcific pathog

Hypopharyngeal SCC

53
Q

Oral mucosal space lesions

3

A

SCC
minor salivary gland Ca
Radiation mucositis

54
Q

Sublingual space lesions

7

A

Ranula

Abscess

Sublingual gland sialadenitis

SL gland carcinoma: mucoep, adenocys, recur late, 90% SL malignant

Sialocoele

Dermoid : ecto/meso

Epidermoid:ectoderm

55
Q

Submandibular space lesions

9

A

SMG sialadenitis

DivingRanula

Pleomorphic adenoma SMG

SMG carcinoma

Sjogrens

Benign lymphoepithelial lesions

Accessory salivary tissue

Second branchial cleft cyst

Kuttner pseudotumour : ch sclerosing sialdenitis, IgG4

56
Q

Root of tongue lesions

5

A

Abscess

SCC invasion

Thyroglossal cyst

Dermoid/epidermoid

Ectopic thyroid tissue

Foregut duplication cyst:bowel layers on USS

57
Q

Transpatial neck lesions

6

A

Venous malformation:slow flow, phleboliths

Venolymphatic malf : lymp > FF levels

Infection

SCC

Lymphatic malformaton:bld fluid levels no CE

Plexiform NF

58
Q

Laryngeal lesions

13

A 
SCC
VC paralysis
LAryngocoele
Laryngeal reflux
Other tumours : chondrosarc, para, papilloma, melanoma, infla pseudo

Wegeners : subglott sten, PNS

RA : cricoary, cricothy

Amyloidosis : mc supragl

OTHERS
thyrogloss duct cyst
lymphadenopathy
parathyroid adenoma
4th branchial cleft cyst : adj or within thyroid
Thymic remnant
59
Q

Thyroid enlargement

9

A
  1. MNG
  2. Thyroiditis : Autoimmune >Hashimoto : pappl ca, NHL
    Graves
    Riedels: Ig4, woody, mimic anaplas
    Postpartum 5-9%
    De Quervains : viral URTI, tender painful
    Suppurative thyroiditis: rare
  3. Primary thyroid Carcinoma
    Papillary : 3-4th decade, fine microca , F>M, ill defined, 50% LN , cystic, I 123 +ve, pertech negative
    Follicular: 5-6th, late LN, conc pertech, not I 123; resect
    Medullary: 5%, 3-4th, MEN 2A/B, coarse Ca, raised calcitonin
    Anaplastic : 1-2%, 6-7th, 5yr 5%, LN/mets common
  4. Thyroid adenoma

5> Lymphoma : NHL, Hashimotot RF, 50-70s

  1. Thyroid mets: br, rcc, colon,lung
  2. Paraganglioma
  3. 4th Branchial
  4. Parathyroid adenoma mimic
60
Q

LN assessment features

A 
Size
Shape : round/oval
Echogenicity
Nodal border
Hilum
Calcification
Necrosis
Vascular pattern
Other : matting, oedema ST
61
Q

Cystic bony lesions of the mandible/maxilla

10

A

Periapical/radicular cyst : < 1cm, apex of dead tooth

Nasopalatine duct cyst: central incisive canal, heart shaped

Dentigereous cyst : crown of unerupted tooth, mandible, third molar, uniloc

Odontogenic keratocyst : benign, aggresive,recur, post mandible, 3rd molar, gorlin goltz, near crown, solitary, uniloc, keratin signal

Ameloblastoma : benign, aggress, 30-50, mandible, third molar, MULTILOCULAR BUBBLY EXPANSILE CE NODULE/SEPTA, No Ca
malig 1%

Residual cyst : site of extraction

SBC : 10-30y, trauma 50%, uniloc, marg scl FFL

ABC : <20, ramus, uni multi, FFL, bubbly, honeycomb CE no nodules

Primordial cyst : dental follicle without tooth

Stafne cyst : mimic , medial cortical defect, fat/SG, post mandible < 2cm

62
Q

Solid lesions of mandible/maxilla

LYTIC 12

A

Malignant infiltration by adjacent tumour

Myeloma : post mandible

Metastases : mand > max

Lymphoma

Leukaemia

EG

Ewings : 5-25y

Other malignant: odonto, amelo,sarc

Giant cell granuloma: benign

Ameloblastic fibroma: multiloc or uni, crown of unerupted

Odontogenic myxoma : multiloc, sim amelo

Nerve sheath tumour

Intra osseous AVM : multiloc

63
Q

Solid lesions of mandible/maxilla

Sclerotic/calcified/ossified
3/3

A

unrelated to teeth
Osteoma
Mets
Exostosis/torus

Related to teeth
Condensing osteitis
Odontoma : benign hamartoma, impacted tooth
Cementoblastoma : paed/young adults, well def, round,fused to tooth apex

64
Q

Solid lesions of mandible/maxilla

GG/mixed density
8 / 5

A

Unrelated to teeth 8

FD: mono 25%, 50% poly; max>mand>rest of skull

Osteonecrosis : 6-12 mnths post Rt peak

Renal osteodystrophy: floating teeth

Osteosarcoma

Pagets : max>mand

Ossifying fibroma : well def, solitary, expansile,GG; multiple - hyperpara-jaw tumour Xd

Osteoblastoma/OO : painful
<20yrs

Intra osseous haemangioma

Related to teeth

Osteomyelitis : Garre’s scl
Cemento osseous dysplasia : benign hamar, afro/asian
Pindborg tumour : rare, well def, driven snow appearance of trabecular Ca
Adenomatoid odontogenic : rare, well def, lucent, Ca + flakes

Ameloblastic fibroodontoma: rare, well def, lucent, dense mass of enamel

65
Q 
Nasal septal perforation
10
Iatro 3
inflamm 2
infection 2
neoplastic 3
A

Trauma
Cocaine necrosis
Rhinitis medicamentosa

Wegeners : T2 low rel to mucosa, CE ST masses
Sarcoidosis

Nasal septal abscess
Invasive fungal sinusitis

Sinonasal SCC
Lymphoma
Melanoma : 50-90, CE ++

66
Q

PNS lesions without bone destruction

INFLAMMATORY 9

A

Chronic rhinosinusitis: > 12 wk

Acute rhinosinusitis

Retention cyst

Mucocoele

Sinonasal polyposis

Solitary sinonasal polyp : antrochoanal MC

Allergic fungal sinusitis

Mycetoma : T2 low

Silent sinus Xd : ch occlusion, retraction, enoph

67
Q

PNS lesions without bone destruction

Neoplastic 5

A

Osteoma : gardner multiple
Inverted papilloma : benign, entrapped bone, tumorous ca, 40-70yrs, midd meatus, focal hyperostosis, cerebriform CE

Juvenile angiofibroma

Pleomorphic adenoma ; minor SG

Nerve sheath tumour

68
Q

PNS lesions with bone destruction 9

A

Sinonasal SCC

Invasive fungal sinusitis : acute, granulomatous, chronic

Olfactory neuroblastoma : peritumoral cyst, dumbell shaped, two peaks, recur later

Wegeners

Lymphoma

Other carcinomas

Sarcoidosis

Osteosarcoma : 30-50y

Chondrosarcoma

69
Q

Lesions of GLOBE

13

A 
Haemorrhage
Retinal (V)/choridal detachment
Orbital pseudotumour
Melanoma
Endohthalmitis
Ocular calcification : Drusen, choroidal osteoma, phthisis
Surgical inserts : scleral buckle, silicone oil
Staphyloma (acq)/ coloboma ( congenital) : post outpouchings
Choroidal haemangioma
Lymphoproliferative lesions
Ocular mets
Sarcoidosis
Retinoblastoma
70
Q

Lesions of ON or sheath

6

A

ON sheath meningioma : tram track, ca, CE, spares distal end

Optic pathway glioma: ca rare

Optic neuritis : 15-50, MS 50%

Orbital pseudotumour

  1. Lymphoproliferative lesions ‘tram-track’ enhancement.
  2. Sarcoidosis*— May ‘tram-track’ enhancement
71
Q

Intraconal fat orbital lesions

A

Orbital pseudotumour

cavernous haemangioma

venous varix : valsalva, intense CE, phelob

Lymphoproliferative

Sarcoidosis

Erdheim chester - T1/T2 low

Nerve sheath tumour

72
Q

Conal lesions

A

Thyroid oph : AI, Graves, IM SLO EOM involvement, > 5mm belly

Orbital pseudo:painful, unilat SR/MR/SO, Ig4

Lymphoprolifer

Sarcoid

Mets

Extra ocular myositis

Rhabdomyosarcoma <15y

73
Q

Extraconal lesions
arising within orbital cavity
7

A

Lymphoproliferative lesions : > 60y, T1/T2 high

Orbital pseudotum : lacrimal, Tolosa Hunt

Pleomorphic adenoma

Malignant lacrimal gland tumour : ad cystic

Sarcoidosis

Sjogrens

Dacrocystocoele

74
Q

Extraconal lesions

arising within wall

A

Subperiosteal abscess

Mucocoele

Sinonasal SCC

Mets

Dermoid/Epi

Sphenoid wing dysplasia: NF1, empty orbit sign

FD

Pagets

Intra osseous meningioma

75
Q

EAC lesions

9

A

wax

cholesteatoma: no CE

Carcinoma : SCC

Necrotising OE : elderly,DM,immuno

Congenital ear malformations

Osteoma : junction

Exostosis: ch water exposure

Medial canal fibrosis: BL50%, cresc fibrous tissue

Keratosis obturans: abnor acc keratin, BL 50%

76
Q

ME lesions

8

A

Chronic OM

Acq cholesteatoma : DWI+, T1 low, T2 high, no CE

Cholesterol granuloma : ch OM, T1 high, T2 high, no CE

Glomus tympanicum : coch promontory paragangl, 40-60

Glomus jugulare : jug foramen, multiple - MEN,NF1, salt pepper appearance MRI

Acute otomastoiditis with abscess

Dehiscent jugular bulb:sigmoid plate dehis

Aberrant ICA : petrous portion

Intra osseous meningioma

ME Schwannoma: Iry/IIry

Perineural spread of tumour VII

Endolymphatic sac tumour : spora/vHL

77
Q

Petrous apex lesions

normal variants 3

A

Asymm marrow
Trapped fluid : prev otomastoi
Petrous apex cephalocoele

78
Q

Petrous apex lesions :
well defined, expansile, remodelling
5

A

Cholesterol granuloma: MC

Epidermoid

mucocoele

CN V scwannoma

Petrous ICA aneuryms

79
Q

Petrous apex lesions : DESTRUCTIVE 5

A

Mets : apex MC site

Petrous apicitis:Gradenigo Xd

Chondrosarcoma

Plasmacytoma

LCH

80
Q

Petrous apex lesions : others 3

A

Meningioma
Pagets
FD

81
Q

Diffuse or multifocal skull base lesions

8

A

METS

Pagets

FD

Myeloma

OSteomyelitis

LCH: bevelled, button

Intracranial inflamm pseudotum(Tolosa)

Lymphoma : nasal/PNS, homogen ST mass

82
Q

Unifocal skull base lesion

7

A

Any multifocal

Meningioma

Chondrosarcoma : synchondroses, often low grade

ICA aneurysm

Ossifying fibroma

Haemangiopericytoma : rare, meninges tumour, CE ++, no Ca/hyperostosis, 30-40y

GCT: v rare, 3-4th, sphenoid, T2 low haemosiderin

83
Q

Clivus lesions

6

A

Skull base lesions not sp for clivus : FD,pagets,mets,lym MM

NPC

Pituitary macroadenoma

Chordoma

Chondrosarcoma : paramidline

Ecchordosis physaliphora : notochordal, stalk

84
Q

Jugular foramen lesions

4

A

Glomus jugulare

Schwannoma

Necrotising OE

Skull base lesions non sp

DDx Summary cards (1 decks)

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