Bones Flashcards
Generalised Increased Bone Density (Adult)
- MYELOPROLIFERATIVE: myelofibrosis
- METABOLIC: renal osteodystrophy
- NEOPLASTIC (probably multifocal rather than generalised):
- Osteoblastic metastases (commonly breast and prostate)
- Lymphoma
- Mastocytosis - IDIOPATHIC: Paget’s Disease
Solitary sclerotic bone lesion
- DEVELOPMENTAL: Fibrous dysplasia, enostosis (bone island)
- NEOPLASTIC:
- Metastasis (prostate/breast)
- Lymphoma
- Osteoma/osteoid osteoma/osteoblastoma
- Healed/healing benign or malignant bone lesion: lytic mets treated with chemoRT, fibrous cortical defect, eosinophilic granuloma, brown tumor
- Primary bone sarcoma - VASCULAR: bone infarct
- TRAUMATIC: callus (esp around stress fracture site)
- INFECTIVE: sclerosing osteomyelitis
- IDIOPATHIC: Paget’s disease
Multiple sclerotic bone lesions
- DEVELOPMENTAL
- Fibrous dysplasia
- Osteopoikilosis
– Osteopathia striata (Voorhoeve’s disease)
– Tuberous sclerosis - NEOPLASTIC:
- Sclerotic metastases
- Lymphoma
- Mastocytosis
- Multiple healed/healing benign/malignant lesions
- Multiple myeloma (sclerosis in 3%)
- Osteomata (e.g. Gardner’s syndrome)
- Multifocal osteosarcoma - IDIOPATHIC: Paget’s disease
- VASCULAR: bone infarcts
- TRAUMATIC: callus
Bone sclerosis with periosteal reaction
- TRAUMATIC: healing fracture with callus
- NEOPLASTIC:
- metastasis
- osteoid osteoma/osteoblastoma
- osteosarcoma
- Ewing’s sarcoma
- Chondrosarcoma - INFECTIVE:
- chronic osteomyelitis (sclerosing osteomyelitis of Garre, Brodie’s abscess)
- Syphillis - DEVELOPMENTAL/IDIOPATHIC:
- Caffey’s disease (idiopathic cortical hyperostosis)- massive periosteal new bone along diaphyses. tender and painful soft tissue swelling, erythema, fever, and irritability.
- Melorhosteosis (molten wax of burning candle)
Coarse trabecular pattern
- Paget’s disease
- Osteoporosis
- Osteomalacia
- Hemoglobinopathies- especially thalassemia
- Hemangioma - esp in vertebral body
- Gaucher’s disease
Coarse trabecular pattern
- Paget’s disease
- Osteoporosis
- Osteomalacia
- Hemoglobinopathies- especially thalassemia
- Hemangioma - esp in vertebral body
- Gaucher’s disease
Skeletal metastases by their common radiological appearance
MIXED/SCLEROTIC:
- breast
- prostate
- carcinoid
- cervical
- testis
- gastric
LYTIC, EXPANSILE:
- Renal cell carcinoma
- Thyroid
- Pheochromocytoma
- Melanoma
LYTIC:
- SCC
- lung
- rectal, colon (occ sclerotic)
- uterus, ovary
- Wilm’s tumor
- bladder (occ sclerotic)
- neuroblastoma (occ sclerotic)
Sites of origin of primary bone neoplasm
Non-aggressive lucent lesion in the medulla (well-defined, marginal sclerosis, no expansion)
- Geode – a subarticular cyst. Other signs of arthritis.
- Healing benign or malignant bone lesion – e.g. metastasis, eosinophilic granuloma or brown tumour.
- Brodie’s abscess.
- Benign bone neoplasms:
(a) Simple bone cyst.
(b) Enchondroma.
(c) Chondroblastoma. - Fibrous dysplasia.
Indeterminate lucent lesion in the medulla (well-defined, NO marginal sclerosis, no expansion).
- Metastasis – especially from breast, lung, kidney or thyroid.
- Multiple myeloma. (look for multiplicity)
- Eosinophilic granuloma.
- Brown tumour of hyperparathyroidism.
- Benign bone neoplasms
(a) Enchondroma.
(b) Chondroblastoma.
Aggressive lucent lesion in the medulla (ill-defined)
- Metastasis.
- Multiple myeloma.
- Osteomyelitis.
- Lymphoma of bone.
- Long bone sarcomas
(a) Osteosarcoma.
(b) Ewing’s sarcoma.
(c) Central chondrosarcoma.
(d) Fibrosarcoma and malignant fibrous histiocytoma.
LUCENT BONE LESION IN THE MEDULLA
– WELL-DEFINED, ECCENTRIC
EXPANSION
- Giant cell tumour*.
- Aneurysmal bone cyst*.
- Enchondroma*.
- Non-ossifying fibroma (fibrous cortical defect)*.
- Chondromyxoid fibroma*.
LUCENT BONE LESION – GROSSLY
EXPANSILE
Malignant bone neoplasms:
1. Metastases – renal cell carcinoma and thyroid; less commonly melanoma, bronchus, breast and phaeochromocytoma.
2. Plasmacytoma
3. Central chondrosarcoma/lymphoma of bone/fibrosarcoma:
– when slow growing may have this appearance.
4. Telangiectatic osteosarcoma
Benign bone neoplasms:
1. Aneurysmal bone cyst
2. Giant cell tumour
3. Enchondroma
Non-neoplastic:
1. Fibrous dysplasia
2. Haemophilic pseudotumour (see Haemophilia) – especially in the iliac wing and lower limb bones. Soft-tissue swelling.
± Haemophilic arthropathy.
3. Brown tumour of hyperparathyroidism*.
4. Hydatid.
‘MOTH-EATEN BONE’ IN AN ADULT
Neoplastic:
1. Metastases.
2. Multiple myeloma.
3. Leukaemia – consider when there is involvement of an entire bone
4. Long-bone sarcomas:
(a) Ewing’s sarcoma.
(b) Lymphoma of bone.
(c) Osteosarcoma.
(d) Chondrosarcoma.
(e) Fibrosarcoma and malignant fibrous histiocytoma.
5. Langerhans’ cell histiocytosis.
Infective:
Acute osteomyelitis.
Osteomalacia and rickets
Vitamin D deficiency
1. Dietary.
2. Malabsorption.
Renal Disease
1. Glomerular disease (renal osteodystrophy*).
2. Tubular disease
(a) Renal tubular acidosis.
(i) Primary – sporadic or hereditary.
(ii) Secondary.
– Inborn errors of metabolism, e.g. cystinosis,
galactosaemia, Wilson’s disease, tyrosinosis, hereditary
fructose intolerance.
– Poisoning, e.g. lead, cadmium, beryllium.
– Drugs, e.g. amphotericin B, lithium salts, outdated
tetracycline, ifosfamide.
– Renal transplantation.
(b) Fanconi syndrome – osteomalacia or rickets, growth
retardation, RTA, glycosuria, phosphaturia, aminoaciduria and proteinuria.
(c) Vitamin D-resistant rickets (familial hypophosphataemia,
X-linked hypophosphataemia)
Hepatic disease:
1. Parenchymal failure.
2. Obstructive jaundice – especially biliary atresia.
If the patient is less than 6 months of age then consider:
1. Biliary atresia.
2. Metabolic bone disease of prematurity – combined dietary deficiency and hepatic hydroxylation of vitamin D.
3. Hypophosphatasia.
4. Vitamin D-dependent rickets.
Madelung deformity. It comprises: (a) short distal radius, which shows a dorsal and ulnar curve;
(b) triangular shape of the distal radial epiphysis;
(c) premature fusion of the ulnar side of the distal
radial epiphysis;
(d) dorsal subluxation of the distal ulna;
(e) enlarged and distorted ulnar head; and
(f) wedging of the triangular-shaped carpus between the distal radius and ulna.
- Isolated – bilateral > unilateral. Asymmetrical. Predominantly adolescent or young adult women.
- Dyschondrosteosis (Leri–Weil disease) – bilateral with mesomelic limb shortening. AD. Predominantly men.
- Diaphyseal aclasis.
- Turner’s syndrome*.
- Post-traumatic.
- Postinfective.
Pseudo-madelung. Refers to increased radial inclination (i.e. ulnar tilt) of the distal radius but with negative ulnar variance and the absence of other typical features of Madelung deformity
hereditary multiple exostoses
post-trauma, e.g. physeal injuries
rickets
enchondromatosis - Ollier disease 1
post-inflammatory or infectious arthritis
achondroplasia
mucopolysaccharidoses, e.g. Morquio syndrome, Hurler syndrome
