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1
Q

What gives superolateral migration of the humeral head? Where does the osteophyte form and why?

A

OA

Medial cortex of femoral head due to shifting of weight bearing

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2
Q

What causes medial migration of the femoral head?

A

Secondary to acetabular fracture

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3
Q

What causes axial migration of the femoral head?

A

Inflammatory arthropathies, crystialline arthropathies

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4
Q

Give the disease for axially migrated femoral head based on the secondary chages:

osteoporosis with bilateral involvement, little if any subchondral sclerosis, no osteophytes

bilatreal, cuff of osteophytes ate femoral head and neck junction

asymmetric, calcified cartilage, indolent (degen rather than destruction), subchondral sclerosis and osteophytes (NOT the medial femoral neck as in OA)

Absence of white cortical line along extensive portion of femoral head

A

RA - can see acetabular protrusio

Ankylosing spondylitis

CPPD

Septic arthritis

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5
Q

What are two primary BONE disorders that cause AXIAL migration of the femoral heads

A

Pagets and renal osteodystrophy

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6
Q

What 4 conditions do NOT cause loss of hip joint space until late in the disease

A

Osteonecrosis, synovial chondromatosis, PVNS, TB

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7
Q

What is the imaging of osteonecrosis of the femoral head

A

Initially, there will be a smudginess of the normal trabecular pattern, followed by lytic and sclerotic areas. There will be a subchondral crescent shaped lucency indicating impending collapse

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8
Q

Differentiate osteonecrosis from late stage OA

A

Osteonecrosis will have far more extensive change in the femoral head

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9
Q

What is the best radiographic sign to diagnose synovial chondromatosis

A

scalloping defect along neck and femur

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10
Q

Differentiate PVNS from synovial chondromatosis

A

PVNS - asymmetric, well defined cysts on both sides of the joint, scalloping defects

SC - bilateral, no cysts

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11
Q

Total knee compartment loss is suggestive of what?

A

Inflammatory arthropathy

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12
Q

How does RA present in the knee

A

bilateral symmetric disease with uniform joint loss with generalized osteoporosis. LITTLE EVIDENCE of bone repair or osteophyte formation

can see large synovial cysts

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13
Q

What are the knee findings in psoriatic/reiters arthritis

A

bilateral ASYMMETRIC disease with maintained bone mineralization

Will see bony excrescences at ligamentous and tendinous attaachments

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14
Q

What are the knee findings in juvenile chronic arthritis

A

Unilateral but total knee involvement

OVERGROWTH of the femoral and tibial epiphyses with overgrowth of the patella

lucent metaphyseal band due to increased blood flow

widening of the intercondylar notch

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15
Q

What are the findings in the knee in hemophilia?

A

Overgrowth of the epiphyses and patella with widening of the intercondylar notch and a SQUARE patella

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16
Q

DDx for overgrowth of the epiphyses and patella with widening of the intercondylar notch in the knee

A

JRA, hemophilia

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17
Q

What are the features of a septic knee joint

A

UNILATERAL

Effusion, uniform cartilage loss, juxtaarticular osteoporosis, loss of white cortical line

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18
Q

What two processes show preferential joint space loss in the knee

A

OA, CPPD

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19
Q

Which joint space is preferentially affected in OA?

A

medial tibiofemoral due to mechanical stress

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20
Q

What are the findings in a neuropathic joint?

A

6 D’s

Dense (subchondral sclerosis)
Degeneration
Destruction of cartilage
Deformity
Dislocation
Debris
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21
Q

Which joint is preferentially involved in the knee in CPPD?

A

Patellofemoral

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22
Q

Scalloped defect in the femur superior to the location of the patella in the flexed position is suggestive of what arthropathy?

A

CPPD

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23
Q

What are the four common disorders that do not cause loss of the knee joint until late in the disease

A

Osteonecrosis, OCD, synovial osteochondromatosis, PVNS

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24
Q

AVN of the femoral condyle is associated with what two disease processes

A

Lupus, steroids

Also seen in SONK

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25
How does osteonecrosis of the knee present radiographically
Ill defined areas of lucency and bone repair in the involved condyle - asymmetric Subchondral lucency and displacement of the cortical fragment inward are pathognomonic
26
How does an OCD lesion in the knee develop?
Chronic repetitive trauma to an area of normal irregular ossification during growth
27
What joint is most commonly involved in PVNS?
Knee
28
Most common cause of bilateral oasteoarthritic changes in the shoulders?
CPPD
29
What is the cutoff for subacromial narrowing? What does it indicate?
7mm Chronic rotator cuff tear, impingement
30
Bony excrescence under the acromion, flattening and sclerosis of the humeral head, and bony proliferation of the greater tuberosity suggest waht in the shoulder?
Impingement
31
What are the causes of distal clavicular osteolysis?
SHIRT Pocket ``` Scleroderma Hyperparathyroidism Infection RA Trauma Progeria ```
32
Total compartmental involvement (GH, AC, Subacromial) in the shoulder suggest what kind of process?
Inflammatory
33
What findings suggest psoriatic over RA in the shoulder?
Preserved mineralization ossification at the rotator cuff attachment and CC ligament less prominent erosive disease
34
A Hatchet deformity, or large erosion of the superolateral aspect of the humeral head, suggests what?
Ankylosing spondylitis
35
Inferolateral displacement of the humeral head with subchondral cysts suggest what?
Hemophilia
36
What two diseases do not cause joint space loss in the shoulder
HADD, osteonecrosis
37
What is the most common cause of shoulder pain?
HADD, or calcific tendinitis
38
What is hadd?
Amorphous calcification in one of the tendons surrounding the joint
39
What are the two types of joint in the SI joint?
True synovial - anteroinferior 1/3 Diarthrodal cartilaginous - posterior 2/3
40
Where do disease processes usually affect first in the SI joint?
Iliac side due to the relative thinness of the overlying cartilage
41
With regards to the SI joint, what causes widening? narrowing? irregularity in the width?
Widening: infection, inflammatory Narrowing: RA irregular: crystalline arhtropathies, OA
42
What separates an erosion in the SI joint involved with gout vs inflammatory arthropathy?
Gout will have a sclerotic well-defined border
43
Where is the sclerosis seen in osteitis condensans ilii
wedge shaped on the iliac side
44
Anterior osteophyte formation of the SI joint is seen in what two diseases
Crystalline arthropathy and OA
45
Calcified abscess in front of the SI joint is suggestive of what?
TB
46
Where is the tophi in SI gout
anterior inferior aspect
47
Osteitis condesans ilii is associated with what other pelvic ring abnormality? Which view demonstrates it?
Pubic symphisis instability Flamingo view - shifting weight
48
What are sharpeys fibers?
The outermost fibers of the annulus fibrosus, that not covered by the endplate cartilaginous cap
49
What is the difference between the PLL and ALL in terms of attachment to the vertebral body?
The ALL pulls away from the vertebral body approximately 3mm from the end of the body. The PLL is closely adhered the entire length of the body.
50
What is a syndesmophyte? What condition is it seen in?
Vertical ossification bridging two adjacent vertebral bodies; it is the ossification of sharpeys fibers Ankylosing spondylitis Can be seen in psoriatic/reiters/IBD
51
What is a marginal osteophyte? What condition is it seen in?
Horizontal bone extension of the vertebral endplate with contiguous cortex and medulla Seen with degenerative disc disease and spondylosis deformans
52
What is a nonmarginal osteophyte? What condition is it seen in?
horizontal extension or osteophyte observed 2-3 mm away from the actual vertebral endplate. Small ones are seen with DDD and spondylosis deformans and are calles "traction" osteophytes and signify instability When large enough, can turn vertically and form bridging nonmarginal syndesmophytes, these are seen with psoriatic and reiters
53
What are paraspinal phytes? What are they seen in?
ossification of the soft tissue structures that surround the vertebral body, PLL in DISH
54
What is the definition of disc height loss?
Disc height equal to or less than the preceding level
55
What are the radiographic findings in DDD
Disc height loss, vaccuum phenomenon, calcification, marginal/nonmarginal osteophytes, subchondral bone repair
56
What are the spine findings in acromegaly? Ochronosis (alkaptonuria)? Neuropathic spine?
A - DDD with increased AP diameter of the vertebral body O - DDD with calcs/vaccuum and ABSENCE of osteophytes N - extreme DDD with reparative bone, massive osteophytes, bony fragmentation
57
What is spondylosis deformans?
Small marginal and or nonmarginal osteophytes WITHOUT disc space loss or DDD Degeneration of sharpeys fibers
58
What is ankylosing spondylitis?
Ossification of sharpeys fibersand deep ALL ascends from lumbar to cervical leading to bamboo spine disc spaces are maintained
59
how do psoriatic and reiters appear in the spine
Asymmetrical and exuberant Usually bridging nonmarginal osteophytes with preservation of disc space Indistinguishable, but psoriasis tends to affect spine much more than reiters
60
How does DISH present in the spine?
Excessive ossification anterior to the vertebral bodies DOESNT ossifiy sharpeys fibers unlike AS, so there will be a lucent Y or T shaped configuration where the ALL pulls away from the vertebral body Must affect at least 4 contiguous vertebral segments
61
How does one differentiate between DISH and inflammatory spondyloarthropathy?
DISH will not affect the SI joints
62
What are the common radiographic findings in RA?
``` Periarticular soft tissue swelling Juxtaarticular/generalized osteoporosis Uniform joint space loss Lack of bone formation Marginal erosions Synovial cysts Subluxations Symmetrical distribution Hands > feet > knees > hips > cervical spine > shoulders > elbows ```
63
What are the earliest radiographic changes in RA?
soft tissue swelling and juxtaarticular osteoporosis
64
Where are RA erosions first seen in the hand? Where do they occur in the wrist?
radial aspect of base of proximal phalanges navicular waist, capitate waist, articulation of hamate with base of fifth metacarpal, first CMC, radial/ulnar styloid
65
What is the distribution of ankylosis in late stage RA?
CMC only, will not see bony ankylosis distal to the carpals
66
Where do erosions affect the feet first? lateR?
Lateral aspect of fifth metatarsal head, followed by other metatarsal head medial aspect then lateral aspect
67
What are the hip findings in RA?
Acetabular protrusion, erosions, osteoporosis ABSCENCE of osteophytes and bony remodeling
68
What are the knee findings in RA?
Uniform joint space loss, subchondral cysts, LACK of erosions, bone reparation, osteophytes
69
What is unique about RA in the ankle?
Formation of periosteal reaction along the posterior tibia must be distiguished from stress fracture
70
What is the most frequent finding in the spine in RA?
Atlantoaxial instability - laxity of the transverse ligament holding the odontoid in place
71
Where in the head does RA commonly affect?
TMJ
72
What are the common radiographic findings in psoriatic arthritis?
``` Fusiform soft tissue swelling (sausage digit) Normal bone mineralization Joint space loss Bone proliferation Pencil in cup erosions Asymmetry Hands > feet > SI joint > spine ```
73
What is the main radiographic difference between RA and psoriatic arthritis?
Psoriatic has bone proliferation
74
Where does bone proliferation with psoriatic arthritis occur in the hand? How does it appear?
adjacent to erosions, along the shaft, at insertions of tendons and ligaments Can be exuberant and fluffy or resemble periostitis
75
What is the distribution of psoriatic arthritis in the hand? How does it differ from RA?
DIP/PIP involvement >> MCP or carpal Skip involvement of PIP/MCP (RA will be uniform) and bone proliferation
76
Differentiate psoriatic from ankylosing involvement in the spine?
Psoriatic will have bulky bony outgrowtsh unilateral/asymmetric AS will have symmetric, with (1) squaring of the vertebral body and (2) involvement of the apophyseal joint
77
What is the key feature that differentiates psoriatic from RA and from ankylosing spondylitis?
RA - bony proliferation and normal mineralization AS - erosion
78
What are the classic radiographic findings in Reiters? How is it differentiated from psoriatic?
Fusiform soft tissue swelling Early osteoporosis with late normalization Uniform joint space loss Bone proliferation Ill defined erosions Asymmetric Feet > ankles > knees> SI joints > hands > hips Distribution is key differentiating feature from psoriatic
79
Most common joint involved in reiters?
small joints of foot and calcaneus
80
Foot distribution of reiters vs psoriatic
R - MTP and 1st IP P - PIP and DIP
81
What are the early foot findings in reiters? late?
Early - juxta articular osteoporosis, periostitis Late - uniform joint space loss, marginal erosions
82
What is unique about calcaneal spurring in psoriatic and reiters?
Will angle up towards calcaneus
83
Fluffy periostitis of the distal fibula and tibia suggest which arthritis?
Reiters
84
What is the key feature differentiating reiters from psoriatic?
Distribution lower extremity in reiters
85
What are the classic radiologic findings in ankylosing spondylitis?
Normal mineralization prior to ankylosis/osteoporosis after ankylosis Subchondral bone formation Small erosions NO subluxation or cysts Ankylosis symmetric SI and spine > hips > shoulders > knees > hands > feet
86
What is the "star" refer to in AS SI involvement?
Ossification of the posterior superior ligaments can resemble a star
87
Where is initial spine involvement in AS?
T12 - L1
88
What are the changes associated with early AS in the spine?
Romanus lesions - small erosions of the corners of the vertebral body Shiny corner - secondary reactive sclerosis Squaring of the vertebral body
89
Earliest finding in the spine in AS?
Lack of motion on flexion and extension views
90
What are the c spine findings in AS? What is the danger?
erosion of the odontoid and atlanto axial subluxation can fracture during intubation
91
What are the two types of AS involvement in the SI joint?
Destructive - unilateral, less common, destruction of femoral head and irregularity leading to ankylosis Nondestructive - more common, younger, bilateral, few erosions with a collar of osteophytes preceeding ankylosis
92
Excessive ossification of the coracoclavicular ligament is seen in what disease?
AS
93
What are the classic radiographic findings in OA?
``` Normal mineralization Nonuniform joint space loss Absence of erosions Subchondral new bone formation Osteophytes Cysts Subluxations Asymmetrical Hands > feet > knees > hips ```
94
Differentiate primary from secondary OA
Primary joint space loss is nonuniform Secondary is uniform
95
What is a heberden node? bouchard?
heberden is soft tissue swelling surrounding the DIP bouchard is soft tissue swelling surrounding the PIP
96
What is the difference between the osteophyte in OA and the periostitis in RA and the overflanking in psoriatic
OA - extension of a normal articular surface RA - development of new bone Psoriatic - false appearance of overhanging due to erosion
97
The wrist findings in OA are very specific. Describe them.
JS narrowing, osteophytosis, subchondral sclerosis and cyst formation Involves only the 1st CMC and trapezium-navicular articulations. If other carpal involvement, likely another process Radial subluxation of 1st metacarpal on trapezium
98
Who gets erosive arthritis usually?
Post menopausal females
99
What is the main difference between OA and erosive OA?
Erosive OA has on overlying inflammatory component
100
What is the difference between erosive OA and psoriatic?
EOA - central erosions (seagull), osteophytes P - marginal erosions, no psteophytes
101
Where is osteophyte/new bone formation in the hip in OA? What is the mechanism
Ophyte - medial femoral head New bone - medial cortex Due to incongruity of femoral head stress secondary to superolateral migration
102
What are the two cysts in OA?
Inclusion - immediately subchondral Contusion - far from joint, completely enclosed in bone
103
Within the knee in OA, where does the tibia sublux relative to the femur? Where is the most common site of osteophyte formation
Lateral Medial aspect medial condyle
104
What do bony excrescences in the knee in OA represent?
areas of cartilage loss
105
What are the spine findings in OA?
Affects the apophyseal joints only; joint space loss, bony sclerosis
106
Disc height loss, osteophyte formation and subchondral bone sclerosis in adjacent vertebral bodies in the spine in the setting of OA should be called what?
Degenerative disc disease the disc is not a synovial joint, and OA is a synovial process
107
What are the radiologic findings in a hypertrophic joint? (chronic)
``` dissolution of the articulation severe subluxation/dislocation new bone formation mammoth osteophytes fragmentation and osseous debris asymmetric involvement foot > ankle > knee ```
108
What is the most common finding of neuropathic osteoarthropathy in the foot
long standing lisfranc fracture-dislocation with extensive eburnation and fragmentation around the TMT joints
109
What joints are involved most commonly neuropathic in tabes dorsalis
knee and hip
110
What are the radiographic features in an atrophic joint? (acute)
extensive bone resorption sharp edges resembling surgery normal mineralization in adjacent bone absence of bone repair surgical joint with bony debris in the soft tissues
111
What is the most common cause of neuropathic OA in the shoulder
syringomyelia
112
What are the characteristic findings in DISH?
``` normal mineralization flowing ossification of at least 4 contiguous vertebral bodies preservation of disc spaces appendicular ligamentous ossification absence of joint abnormality ```
113
whiskered iliac crests, ischial tuberosities, and femoral trochanters suggests what?
Extraspinal DISH
114
Ossification of the pubis symphysis and posterosuperior SI joint (nonsynovial) suggests what
DISH
115
Where does DISH affect the knee?
Inferior and superior attachment of the patellar tendon
116
What is the main difference between OA and DISH?
OA will have joint changes (space loss, vaccuum disc, subchondral sclerosis) DISH (1) doesnt affect the joint itself and (2) affect ligamentous and tendinous attachments
117
Where does DISH affect the humerus and hand?
Humerus - deltoid protuberance Hand - phalangeal shafts
118
What are the two types of gout? What is the difference radiographically
Primary - inborn error of metabolism Secondary - increased production/decreased excretion Secondary has no radiographic changes
119
What are the radiographic findings in gout?
``` Tophi normal mineralization joint space preservation punched out erosions with sclerotic borders overhanging cortex asymmetric feet > ankles > knees > hands ```
120
What is a tophus?
soft tissue mas created by deposition of urate crystals. Urate is not radiographically opaque, but they can precipitate calcium
121
What is the mechanism behind the gouty erosions?
Tophi erode bone in an indolent course. Due to slow process, erosions usually have a sclerotic border, giving a punched out or mouse bite apprearance. As the erosion is progressing the proximal edge of cortex is remodeled in an outward direction creating an overhanging margin
122
Are the changes in gout reversible?
No, but the urate crystals can disappear with treatment, so the tophi can be missing with the osseous findings intact
123
Which aspect of the joint does gout affect?
Dorsal with preservation of the plantar
124
What differentiates gout from OA at the first MTP
The presence of a tophus and bony erosions indicates gout
125
What joint in the hand is preferentially involved in gout
CMC
126
Olecranon bursitis is suggestive of what process?
Gout
127
What are the two diseases that have an association with CPPD
primary hyperparathyroidism and hemachromatosis
128
What three areas should be imaged in suspicion for CPPD
knee, wrist, and pubic symphysis
129
What are the characterisitic features of CPPD
``` Chondrocalcinosis Normal mineralization Uniform joint space loss Subchondral new bone formation Osteophyte formation Cysts (moreso than OA) Bilateral Knees > hands > hips ```
130
Preferential patellofemoral joint space loss with a scalloped defect in the anterior aspect of the femoral condyles is indicative of what process
CPPD
131
Where in the wrist is CPPD most common
TFCC
132
Where in the hand does cPPD affect
MCP joints, spares IP
133
What is the step ladder configuration related to CPPD?
occurs with dissociation between navicular and lunate with accompanying joint space loss between lunate and capitate.
134
Uniform joint space loss of the hip with suchondral sclerosis and cyst formation without osteophyte suggests what
CPPD
135
With regards to distribution, what is the main difference between OA and cPPD
CPPD affects nonbearing joints, such as shoulder and elbow
136
What are the characteristic radiographic findings in HADD
``` Periarticular calcification Soft tissue swelling Normal adjacent bone and joint Occasional effusion Occasional osteoporosis Single joint distribution Shoulder > hip > wrist > elbow > neck ```
137
Where does most HADD occur in the shoulder
Supraspinatus
138
What is the milwaukee shoulder
HADD in the rotator cuff may eventually rupture into the bursa leading to severe secondary arthropathy
139
Where does HADD occur in the hip? elbow? wrist?
Hip - gluteal attachments in the greater trochanter Elbow - medial and lateral condyle of humerus, olecranon bursa Wrist - FCU which shows as calcification adjacent to pisiform
140
Where does HADD affect the spine
longus colli muscle anterior to C2 vertebral body just inferior to atlas
141
What is the physiology behind CPPD in the setting of hemachromatosis
Iron blocks pyrophosphatase activity in cartilage, leading to precipitation of CPPD
142
What are the characteristic radiographic findings in hemachromatosis
``` Osteoporosis Chondrocalcinosis (hyaline > fibrous (CPPD) Uniform joint space loss Subchondral sclerosis Subchondral cysts Beak like osteophytes Symmetric hand/wrist ```
143
Where in the hand does hemachromatosis predominantly affect? what are the characteristic features
2nd and 3rd MCP beak osteophyte on medial aspect of 2nd and 3rd metacarpal Flattening or collapse of metacarpal heads too
144
Which arthropathy has a paint brush appearance?
Wilsons
145
What is ochronosis
Homogentisic acid oxidase deficiency Deposits homogentisic acid which precipitates calcium hydroxyapatite
146
What are the characteristic features of ochronosis
``` Osteoporosis Disc degeneration Uniform joint space loss Extensive subchondral sclerosis Absence of osteophytes Intraarticular loose bodies Symmetric Spine > knee > hip > shoulder ```
147
Differentiate ochronosis from AS in the spine
Ochronosis has loss of disc space with vaccuum phenomenon Also, in the SI joint the changes in ochronosis are more related to OA without erosion or ankylosis
148
What are the radiographic changes in SLE
``` Soft tissue swelling Juxta articular osteoporosis Subluxation and dislocations absence of erosions and joint space loss Calcification Osteonecrosis Symmetric ```
149
What is the hallmark of SLE arthritis?
Subluxation WITHOUT erosion (RA)
150
How does osteonecrosis show up on imaging
The necrosis doesnt show up, its the reparative changes that are visualized ``` Increased smudgy density (dead or repair bone) Subchondral lucency (impending collapse) ```
151
What are the characteristic radiographic findings in scleroderma
Resoprtion of the soft tissue of the finger tip Subcutaneous calcification Erosion of the distal tuft Acrosclerosis/amorphous calcification of the distal phalanx
152
How does dermatomyositis present radiographically?
Soft tissue calcification along intermuscular fascial planes
153
How does polyarteritis nodosa present radiographically?
Periosteal new bone formation limited to the tibia and fibula in a symmetric fashion
154
Preferential ankylosis of the trapezoid in the wrist suggests what?
MCTD
155
How does JRA differ from adult RA?
(1) periostitis in metaphyses of phalanges, metacarpals, and metatarsals (2) significant erosive change WITHOUT joint space loss
156
What are the three presentations of stills disease
1 - systemic disease without radiographic changes 2 - polyarticular disease with less severe systemic manifestations 3- pauciarticular or monoarticular disease with infrequent systemic manifestations
157
What are the radiographic manifestations of stills disease
``` Periarticular soft tissue swelling Osteoporosis Periostitis Overgrown or balloon epiphyses Advanced skeletal maturation Late joint space and erosion Ankylosis Symmetric ```
158
What are the hand findings in stills disease
MCP, PIP, and DIP involvement (vs RA, no DIP) Periarticular soft tissue swelling and juxtaarticular osteoporosis Overgrowth and ballooning of the epiphyses with premature closure of the growth plate leading to brachydactyly Can have epiphyseal compression fractures leading to flattening of the metacarpal heads and cupping of the proximal phalangeal ossification center
159
How does stills affect the wrist
Acceleration of growth maturation in the carpals with leads to bony irregularity leads to ankylosis usually involves 2/3 compartments (spares radiocarpal)
160
How does stills affect the ankle mortise
Tibiotalar tilt secondary to overgrowth of the epiphyses and premature closure of the epiphyseal plate
161
In mono or pauciarticular JRA, which joint is most commonly affected? How?
Knee ST swelling, juxtaarticular osteoporosis Metaphyseal lucent band (increased blood flow to the synovium) Overgrowth of the femoral and tibial epiphyses, leads to widened intracondylar notch squaring of the patella
162
What are the hip findings in stills? what about the c spine
Enlargement of the femoral head with acetabular protrusio and flattening of the femoral head due to compression fractures Ankyloses of the apophyseal joints What are the mandibular findings
163
What are the mandibular findings in stills
shortening of the body and vertical rami of mandible
164
What are the articular changes in hemophilia
``` Radiodense soft tissue swelling Osteoporosis Overgrown/ballooned epiphyses Subchondral cysts Late joint space loss and secondary OA Asymmetric Knee > elbow > ankle > hip > shoulder ```
165
What are the hemophilia findings in the knee
Dense soft tissue swelling and joint effusion with overgrowth of the femoral and tibial epiphyses causing widening of the intracondylar notch Squaring and ballooning of the patella inferiorly
166
What is the finding in the ankle mortise in hemophilia
Tibiotalar slant
167
What are the shoulder findings in hemophilia
Widened GH space with inferior displacement of the humeral head Soft tissue swelling with subchondral cyst formation
168
How does a pseudotumor in the bone associated with hemophilia appear
Radiolucent lesion with well defined border +/- sclerosis. Septated with varying degrees of cortical destruction and periosteal bone formation
169
What are the main differentiating features between JRA and hemophilia
Hemophilia will have radiodense soft tissue secondary to blood as well as SUBCHONDRAL CYSTS

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