Conditions pictures Flashcards
RA articular ssx
- Insidious onset of pain, tenderness, swelling and stiffness of joints.
- Symptoms worse in the morning.
- Bilateral symmetric peripheral joint involvement is hallmark.
- Interphalangeal and metacarpophalangeal joints initially affected, with disease progressing proximally.
80% of cases eventually end in the Cx. Spine
- Haygarth’s nodes: Rheumatoid soft tissue nodules at MCP joints
- Arthritis mutilans: Severe polyarticular destruction and joint deformities.
- Baker’s cyst: Fluid filled gastrocnemius-semimembranosus bursa.
- 188
- “Button Hole”: rupture; rupture of extensor digitorum tendon at PIP joint.
- Boutonniere deformity: PIP flexes, DIP extends as extensor digitorum tendon ruptures at PIP joint
- Swan Neck deformity: PIP extends, DIP flexes
- Mallet finger: DIP fixed in flexion; when extensor digitorum communis tendon ruptures at base of distal phalanx.
- Hitchhikers thumb: Boutonniere at thumb.
What condition is this?
RA
What is this condition? Describe some of the lesions you see
Ra
Periarticular soft tissue swelling; fat lines displaced, soft tissue density increases.
Juxtaarticular osteoporosis: inflammatory hyperemia causes epiphyseal and metaphyseal osteopoenia.
Uniform loss of joint space
Marginal erosions (rat bite erosions); loss of cortex at bare areas, no sclerotic border
Juxtaarticular periostitis (occasional), solid or single lamination
Pseudocysts: frequently 4-6 cm in diameter; intraosseous pannus and synovial fluid; simulate subarticular neoplasm or infection.
Articular deformity: joint destruction, ligament laxity, altered muscle function, leads to subluxation or dislocations, ulna Deviation common.
What is the arrow pointing to? what condition is this?
A marginal erosion (rat bite lesion)
RA
What condition is this?
RA
What condition is this?
RA
Describe this image. What condition is this?
RA
Widespread osteopaenia, multiple joint destruction with rat bite lesions and pseudocysts. Note multiple areas of subchondral sclerosis.
Slight ‘fluffy’ periosteal reaction but due to the severity of the destruction there wont be much periosteal response.
Pencil in cup deformity of PIP of 5th digit.
Lanois deformity of the toes with severe joint subluxation.
What kind of derformity is this? What condition is it in?
Swan neck deformity
RA
Describe this image
Cortical thinning
Multiple pseudocysts
Ulnar deviation
Soft tissue swelling
RA invariably spares the DIP’s
How would you describe the appearance of the distal ends of the metacarpals?
Whittled
What lesion is this?
Giant Cell Tumor
- *Radiological appearance:**
- (LEFT PHOTO) Eccentrically located, sharply circumscribed lytic lesion (60%) = wide zone of transition
- (RIGHT PHOTO) Soap bubble appearance (40%) = expansial
- Thin expanded cortex with wide ZOT at endosteal margins
What is this lesion?
Giant Cell Tumor
What condition is this?
What is this lesion appearance?
What other conditions have this lesion?
What condition is this? Plasmacytoma
What is this lesion? Soap bubble
What other conditions have this lesion?
Giant Cell tumor can have soap bubble appearance
What conditions is this?
What are the pain descriptions of the lesion?
Radiological Appearance:
- Large lucent, round or oval shaped
- Poorly defined margins
- Expansile
- Endosteal scallopping (focal resorption of the inner margin of cortical bones)
- *Medulla** -Bubbly matrix with mottled appearence
- Cotton wool appearance
- *Periosteal Response** -laminated or spiculated
What condition is depicted in these images?
**Ewings Sarcoma
Margin:**
-Diaphyseal permative lesion with wide zone of transition
- *Periosteum:**
- Up to 50% are “Onion skin periosteal response” (demonstrates multiple concentric parallel layers of new bone adjacent to the cortex)
- May see groomed whiskers appearance of periosteum (A pattern characterised by hair-like periosteal projections perpendicular to bony trabeculae)
- *Cortex:**
- Saucerisation “scalloped depression in cortex”
- *Medulla:**
- Usually mixed lytic and sclerotic pattern
- *Osteochondroma**
- Exostoses are defined as benign growths of bone extending outwards from the surface of a bone.
- *Radiological**
1. Pedunculated: commonly originate from metaphysis (e.g. distal femur or proximal tibia) - Stalk continuous with bone cortices and has osteo-cartilage cap.
2. Sessile broad based, long asymmetrical widening of bone
3. Cauliflower: Large lobulated cap, common sites pelvis and ribs
-Pathological #’s are common
What is this condition?
Describe the lesion?
Haemangioma
Medulla:
-Corduroy cloth (The corduroy sign refers to a vertically oriented, thickened trabeculations in the spine. )
- Round Osteolucent or oval osteolucent appearance in frontal bones
- Other bones may show: Honeycomb appearance, expansile when in long bones, can show mixed osteolytic, osteosclerotic appearance.
- *Endplate:**
- Vertebral endplates unaffected
- *Periosteal:**
- Often has fine dense spicule raditating from the centre “Sunburst or spoke wheel appearance”
- Axial CT will show a “polka dotted” apperance due to the thickened vertebral trabeculae
- Flattend endplate
- Squaring/ picture frame?
What lesion is this?
Bone island
“There is an oval radiopacity within the ischium which repersents a large bone island.
Of notice there is an ovarion shield seen obscuring the pelvic basin and a portion of he pelvic brim”
What is this lesion?
Osteoid osteoma
*Hallmark photo*“Well-defined radiolucent tumor nidus within the medullary component of the diaphysis of the 5th met. Reactive sclerosis and appositional periostel new bone surround the tumour nidus”
- Lucent nidus with surrounding scleoris
- Solid periosteal response becomes evident
What is this lesion?
Osteoblastoma
“Observe the expansile lytic lesion of the posterior tubercle of the atlas *arrow* The geographic destruction leaves clearly defined peripheral cortical margin, suggesting the bengin nature of the tumor”
- -Expansile lesion, clearly defined eggshell thin cortical rim
- Most are lucent some may be mottled and generally 4-6cm in diameter*
What is this lesion?
Osteoblastoma
“Destruction of the lamina and lucency of C2 body is apparent”
-Expansile lesion, clearly defined eggshell thin cortical rim
-Most are lucent some may be mottled and generally 4-6cm in diameter
What is this lesion??
Describe it?
Osteoblastoma
Radiological appearance:
Spine:
-Expansile lesion
-Clearly defined eggshell thin cortical rim
-Most are lucent some may be mottled and generall 4-6cm in diameter
-In extremities see lytic expansile lesion in the metaphyses or diaphysis
What is this lesion?
Describe it?
- *Chondroblastoma**
- Oval or round lytic lesion in epiphysis with a sharp zone of transition.
- Geographic and usually eccentric though may be centrally placed
- Fluffy cotton wool appearance
What is this lesion?
“Simple bone cyst of the proximal one-third of the femur was present. This lesion was drained of its serous fluid and struts of bone were placed within the hollow cavity”
*may result in a full hip reconstruction*
- *Radiological appearance:**
- Lucent geographic lesion
- Path #’s
- NO Cortical disruption
- Broad at the metaphyseal end
- Narrowing at the diaphyseal end
- Expansile but expansion does not extend beyond the epiphyseal diameter.
- In the calcaneous characteristic simple bone cyst appearance is geographic, completely lytic lesion at base of calcaneal neck.
- Located inferior to the anterior part of posterior facet (joint articulation)
What is this lesion?
- *Radiological appearance:**
- -Lucent geographic lesion
- Path #’s*
- NO Cortical disruption
- Broad at the metaphyseal end
- Narrowing at the diaphyseal end
- Expansile but expansion does not extend beyond the epiphyseal diameter.
What is this lesion?
What are other DDX?
Simple bone Cyst
- *Radiological appearance:**
- Lucent geographic lesion
- Path #’s
- NO Cortical disruption
- Broad at the metaphyseal end
- Narrowing at the diaphyseal end
- Expansile but expansion does not extend beyond the epiphyseal diameter.
- In the calcaneous characteristic simple bone cyst appearance is geographic, completely lytic lesion at base of calcaneal neck.
DDX:
Brodies abscess
Suppurative osteomyelitis
Pseudocyst
What lesion is this?
Simple bone Cyst
Radiological appearance:
- Lucent geographic lesion
- Path #’s
- NO Cortical disruption
- Broad at the metaphyseal end
- Narrowing at the diaphyseal end
- Expansile but expansion does not extend beyond the epiphyseal diameter.
- In the calcaneous characteristic simple bone cyst appearance is geographic, completely lytic lesion at base of calcaneal neck.
What lesion is this?
**Aneurysmal Bone Cyst
Radiographical appearance:**
- Expanding lytic lesion may reache 8-10 cms
- Eggshell thin periosteal shell
- Usually eccentric creasting saccular protrustions resulting in cortical bulge (ballooning)
-Can appear soap bubble in apperance
- *DDX:**
- Osteoblastoma in spine
- SBC (simple bone cyst)
What lesion is this?
**Aneurysmal Bone Cyst
Radiographical appearance:**
- Expanding lytic lesion may reache 8-10 cms
- Eggshell thin periosteal shell
- Usually eccentric creasting saccular protrustions resulting in cortical bulge (ballooning)
-Can appear soap bubble in apperance
- *DDX:**
- Osteoblastoma in spine
- SBC (simple bone cyst)
What is this lesion?
Aneurysmal Bone Cyst
- *Radiographical appearance:**
- Expanding lytic lesion may reache 8-10 cms
- Eggshell thin periosteal shell
- Usually eccentric creasting saccular protrustions resulting in cortical bulge (ballooning)
-Can appear soap bubble in apperance
- *DDX:**
- Osteoblastoma in spine
- SBC (simple bone cyst)
What is this lesion?
- *Reiters:**
- Involved in up to 70% of reiters patients
- May see ersions hazy joint margins, variable sclerosis, especially on iliac margins
- Altered joint space
- Can progress to ankylosis but not as common as AS
What is this condition?
Reiters finger“marginal erosion (arrows) linear periostitis (arrow heads) and soft tissue swelling (crossed arrows)”
What is this condition?
Reiters Syndrome
Spine:
“Occasionally may result in AA instability or atlas dislocation”
TL manifestations:
-Coarse non-marginal syndemophytes
-May be complete or incomplete
-May be floating type, but unattached to vertebral bodies
What is this condition?
Gout:
- Marginal pannus reaction to cortical loss.
- Periarticular pressure erosions especially with tophi with eccentric locations in metaphysis and diaphysis.
- Sclerotic margins gives “overhanging margin sign” where lip of bone protrudes into soft tissue.
-Erosion of bone around the tophis
What condition is this?
Gout with ulna deviation
- Radiology:*
- Clinical manifestations may precede visible signs 5-10years.
- Soft Tissue: Effusion tophi (5mm to 5cm)
- Joint Spaces: Late loss of joint space, Very rare ankylosis
- Bone Erosions:
- Marginal plannus reaction with cortical loss
- Periarticular pressure erosions especially with tophi with eccentric locations in metaphysis or diaphysis
- Sclerotic margins gives “overhanging margin sign” where lip of bone protrudes into Soft tissue.
-Interosseous well circumscribed, oval or round punched out tophi in medullary cavitiy.
Bone Density: Usually remains normal but may see some subchondral osteopenia.
Periosteum: occasional linear periosteal new bone
Chondrocalcinosis: Uncommon, occurs in triangular cartilage of wrist, knee meniscus, symphysis pubis.
Avascular necrosis: Medullary infarcts, epiphyseal necrosis. at femoral and humeral heads.
What condition is this?
CPPD
Radiology:
Major features:
-Calcification in and around the joint (Pyrophosphate Arthropathy)
- Chondroalcinosis: Calcification of cartilage
- Pyrophosphate athropathy
What condition is this?
CPPD
Radiology:
Major features:
-Calcification in and around the joint (Pyrophosphate Arthropathy)
- Chondroalcinosis: Calcification of cartilage
- Pyrophosphate athropathy
