AP Lumbopelvic Flashcards
Check the lower 1/3 of the SI joints
AS
Osteitis condensans ilia
DJD
AS
Bilateral fusion of the SI joints
Bilateral sacroilitis
Enteropathic arthritis
Gost joints (SI joint fused) and star sign (calcif sup SI joint)
Osteitis Condensans Ilia aka
Hyperostosis triangularis
Osteitis Triangularis
Osteitis condensans ilia
Multiparous females
20-40
Bilateral symmetrical trianglular sclerotic areas on the lower half of the ilium
Osteitis condensans ilia
Osteitis condensans ilia
Joint space is spared
Self-resolving
No labs
Case management osteitis condensans ilia
Trochanteric belt for stability
DJD lower SI joint
Sclerosis ilium side
>40
Bilateral whitening on ilia and sacral sides of SI joint
3 other possiblities aside from DJD
Early AS
PA
Reactive arthritis
Compare one ilium to the other for alterations in color or shape
Color - whiter = blastic mets, pagets
Darker - lytic mets, mm, benign bone tumors
Shape - PFF - paget’s, fractures, fibrous dysplasia
Find L4 and T12 - check for
Lumbarization or sacralization
L5 TPs may fuse or form joints with the sacrum
Sacralization
6 lumbars (1st sacral segment appears like a lumbar segment)
Lumbarization
Check the sacrum for alterations of color, shape, spina bifida, and knife clasp deformity
Color whiter - blastic mets or pagets
Color darker - lytic mets, mm, benign bone tumors (GCT)
Shape - PFCF - paget’s fractures congenital anomalies, fibrous dysplasia
Spina bifida - vertical radiolucency
Knife clasp - elongated L5 SP going into spina bifida of sacrum
Check the square block head system from bottom up
Pedicles = eyes SP = nose TP = ears Body = head
Check L5/S1 facets for
Tropism/asymmetrical facets
Check the body (head)
Hemivertebrae
Butterfly vertebra
Hemivertebrae
Half a VB
Failure of development of a lateral ossification center
Isolated wedged vertebra causes a congenital or structural scoliosis
Associated with scrambled spine appearance - multiple curvatures
Butterfly vertebra
Failure of the center of teh VB to ossify properly
NEVER creates a scoliosis
Butterfly vertebra aka
Receded cortical margins
Indented cortical endplates
Sagittal cleft defect
Increased intrapedicular distance
A crushed/smooshed head
Malignancy - mm/fx
A darker head
Mm or lytic mets
A brighter head
Pagets or blastic mets
Check the pedicles (eyes)
Pedicle agenesis - contralateral pedicle hypertrophy and sclerosis (superpedicle) - other pedicle obviously whiter
Lytic mets of pedicle
Lytic mets of pedicle
Missing pedicle with contralateral side of no color change
Associated with winking owl sign
Check the spinouses (nose)
Spina bifida
Fractures
Missing
Spina bifida
Vertical radiolucency with smooth cortical margins around un-united pieces
Fractures
Double spinous sign
Missing
Agenesis
Malignancy
Surgery
Check the TP (ears)
Fracture
Non-union
Scoliosis
Fracture TP
Bone displaced from itself Fulcrum fracture Psoas and quad lumborum attachment Jagged radiolucency No cortical margins Displacement
Non-union TP
In place No symptoms Smooth Cortical margins present No displacement
Scoliosis named for
Largest or major curve
Named on side of convexity
Rotatory scoliosis
Spinouses deviate away from convexity
Simple scoliosis
Spinouses deviate towards convexity
M/c scoliosis
Adolescent idiopathic simple scoliosis - adams ortho test
X-ray lines scoliosis
Cobb’s
Risser ferguson’s
Case management 25 and younger scoliosis
<20 - adjust and monitor. With fisser’s sign and wrist films
21-40 refer to orthopedist - don’t adjust - milwaukee brace
>40 surgical consultation
Scoliosis can lead to
DJD
Cardiopulmonary compromise
Postural fatigue
Check the ribs - m/c benign tumor
Fibrous dysplasia
Check the ribs
Fractures
Lytic mets
Fractures ribs
Most common condition
Bone displaced from itself
Check the ribs lytic mets
Most common malignancy
Look for teeth marks in the bone
Check the soft tissue from the ribs down to the iliac crest
AAA Renal artery Gallstones Kidney stones Staghorn calculi Pancreatic calcification Calcified spleen Splenic artery calcification Congenital anomaly
AAA on AP view appears like a
Half moon shape from the sides of L2-4
Curvilinear
Radiographic signs AAA
Aortic dilation
Curvilinear calcification
Fusiform appearance
Special test AAA
Doppler ultrasound
Diagnostic US
Ultrasonography
CT
AAA refer to
Cardiovascular specialist
Renal artery
Calcification - smaller cheerio
Aneurysm - larger cheerio
Gallstones
90% can’t be seen (cholesterol) Bag of marbles right upper side R upper quadrant pain Steatorrhea Inc after fatty meal Long hx poor diet
Location at L1-2
Start at iliac crest and work your way up the film
Black center outlined in white
Affiliated with 9 F’s
Gallstones
Gallstones referral pain
To inferior border of the right scapula (viscerosomatic)
Murphy’s inspiratory arrest
Gallstones
Case management gallstones
Gastroenterologist
Small - let pass or lithotripsy
Large or blocking biled duct = surgery (take out Gb)
Special test
Ultrasound and cholecystogram
Kidney stones
90% show up Laying down pisses it off Tx same as gallstones Refer nephrologist Pyelogram ureters
Location L1-2, start at the SI joint and work your way up the film
Solid white in color
Kidney stones
M/c caslicum oxalate
Murphy’s punch
Bloo in urine, change in urinary frequency
Kidney stones
Calcification of the renal calyces Solid white in color Larger than stone Does not affect ureters Surgery
Staghorn calculi
Spotty white calcification that crosses the midline at L1-2 area
Pancreatic calcification
Upper left quadrant T12-L2 area
Does not cross the midline
Calcified spleen
Splenic artery calcification
Worm
Congenital anomaly order affection L5/S1 from most significant to least
Knife clasp Lumbosacral transitional segment Facet tropism Spina bifida L5/S1 Enlarged TP of L5
