DI 2- Final Flashcards
List the three presentations/types of osteoporosis.
o Generalized (Senile/Postmenopausal)
o Regional—dt disuse/immobilization, reflex sympathetic dystrophy (RSD)
o Localized-dt infx, inflammatory arthritis, neoplasm
How does generalized osteoporosis present?
- ↑ bone radiolucency
- cortical thinning; “pencil thin” cortices & endplates
- endplates very radiopaque
- altered trabeculae patterns: no horizontal lines; accentuated vertical trabeculae = “pseudohemangiomatous”
- “Pancake” and anteriorly wedged vertebrae
- Biconcave endplates
- Isolated end plate infarction
- Schmorl’s nodes
How does regional osteoporosis present?
- Acute, Painful: progressive pain, swelling, atrophy
- Usu develops in one area distal to trauma site
- Osseous hyperemia dt neurovascular imbalance
- Patchy, mottled
- Metaphyseal localization
- No joint dz
What is the most common cause of generalized osteoporosis?
o Age o ↓ Estrogen (F > 60, pm) o ↓ Androgen (M) o ↓ intake Vit D and Ca o lack of weight-bearing exercise
What is the standard imaging modality to quantify bone mineral density?
o DEXA (dual energy x-ray absortiometry)
What causes rickets and osteomalacia? 2 forms of rickets?
o ↓ Vit D, mb dt malabsorption
o Osteomalacia: also abN Ca and PO4 metabolism, dietary deficiency, renal dz
o renal osteodystrophy w chronic renal dz
o renal tubular defect (don’t reabsorb phosphate)
What are the classic radiographic features of rickets?
- Generalized osteopenia (bowed appearence)
- Coarse trabecular changes
- Wide growth plates (tall, thick; feels thicker on palp, swollen)
- Rachitic Rosary (bead-like, on sternum)
- no zone of provisional calcification
- Frayed “paintbrush” (growth plate margn) and cupped metaphyses
What causes scurvy and what are the classic radiographic features?
↓ Vit C
o White Line of Frankel – dense zone of provisional calcification, @ metaphysis
o ring epiphysis (Wimberger’s sign)
o Pelken’s spurs, @ metaphysis
o scorbutic zone (Trummerfeld zone)
o subperiosteal hemorrhages dt vascular fragility
What are the classic radiographic features of hyperparathyroidism in the spine, skull, and hand?
- Hand: Subperiosteal resorption, Radial margins of proximal and middle phalanges of digits 2-3 w acroosteolysis (jagged edge)
- Skull: “Salt and pepper” resorption of lamina dura
- Spine: Osteopenia, Trabecula accentuation, End plate concavities, “Rugger Jersey” spine (thick cortical area), Wide SIJs
What are the face, skull, and foot changes seen with acromegaly?
- Face: prominent forehead, Sinus overgrowth, Wide mandibular angle (prognathism)
- Skull: large Sella turcica dt pituitary neoplasm; Sinus overgrowth, Malocclusion
- Foot: heel pad > 20 mm (1 in)
What osseous changes might long term corticosteroids cause?
- Osteoporosis of Cushing’s dz: Thin cortices, ↓density, deformities; Biconcave end plate
- Osteonecrosis: femoral & humeral heads; distal femur and talus; “Intravertebral vacuum cleft sign”: Gas in vertebra, avascular necrosis → vertebrae collapse
The “H”-shaped vertebra is classically seen in what condition?
Sickle Cell Anemia: vertebral bodies are osteoperotic; deformities at endplates (“step off”, “fish vertebrae”, “H” vertebrae, w central depression (hypoplasia of central portion of vertebrae)
What are some complications to the skeleton secondary to sickle cell anemia?
bone changes dt marrow hyperplasia, ischemia, necrosis
• Generalized osteoporosis (marrow hyperplasia)- Thin cortices
• Coarse trabeculae, esp in axial skeleton
• Large vascular channels
• Wide medullary cavity
• Epiphyseal ischemic necrosis
• Medullary infarcts (metaphysis or diaphysis)
• 2nd salmonella or staph aureus osteomyelitis
• Vertebral body collapse
• Posterior mediastinal extramedullary hematopoiesis
Which anemia tends to result in “honeycomb” trabecular patterns?
Thalassemia
Hemophilic arthropathy typically occurs in which joints?
Knee, ankle, elbow (BL, symmetrical)
What is a common ddx when encountering hemophilic arthopathy?
Rheumatoid arthritis
What are the 4 mc sites for aneurysm in the abdomen?
Aorta, Splanchnic (mb mc), Iliac, Femoral
Which condition demonstrates nonuniform joint space narrowing, osteophytes, subchondral sclerosis, & subchondral cysts?
DJD
Which condition presents with triangular sclerosis only at the iliac portion of the lower SI joint?
Osteitis Condensans Ilii
Is osteitis condensans ilii more commonly unilateral or bilat?
BL & symmetric sclerosis
Is osteitis condensans ilii more commonly found in males or females?
• predominantly women of childbearing age
Osteitis pubis is commonly associated with which medical procedure?
• surgery near pubic symphysis, usu lower urinary tract (suprapubic or retropubic prostatectomies)
What is the difference bw marginal & non-marginal syndesmophytes?
- Syndesmophyte= osseous excrescence attached to a ligament
- Non-Marginal Syndesmophytes: don’t come from corners
- Marginal syndesmophytes: ossification of outer annulus fibrosis → thick, vertical radiodense areas; connect adjacent vertebrae.
Which spinal arthritides have marginal vs non-marginal syndespmophytes?
- Marginal: ankylosing spondylitis (AS), bow outward slightly → “bamboo spine” dt extensive syndesmophytes (vs spondylophytes in DJD); AS & Enteropathic: continuous syndesmophytes
- Non-marginal: Psoriatic arthritis (esp at thoracolumbar jxn) & Reiters (=reactive arthritis, dt infx) (both tend to skip levels)
What systemic condition is commonly found in pts w diffuse idiopathic skeletal hyperostosis (DISH)?
- # 1 Osteoarthritis
- # 2 Diabetes
- Dyslipidemia
- Hyperuricemia
• Describe a cervical spine with DISH?
o large bridging anterior osteophytes from C2-T1
o Dense band of calcification along posterior aspect of vertebral bodies
o Mild disc space narrowing at C5-6 and C6-7, minimal narrowing at C3-4
o No evidence of facet joint fusion or narrowing.
Dysphagia is common in which arthritic condition & why?
DISH: spinal involovement, esp ALL & extraspinal ligamentous & tendonous calcification & ossification
• also PLL & Longus colli
• What is intervertebral disc degeneration?
- aka spondylosis
- Loss of disc height
- Osteophytes (spondylophytes (in spine))
- Endplate sclerosis
- Vacuum phenomenon (cleft) (sign of degeneration, lucency in disk)
- Retrolisthesis (MC cause is DJD)
- Central stenosis uncommon (MC cause is facet degeneration vs disk degeneration)
List the radiographic findings of Neuropathic Arthropathy:
6 D’s =pathognomonic 1. Distended Joint 2. Density ↑ of subchondral bone 3. Debris or loose bodies 4. Dislocation 5. Disorganization Joint 6. Destruction of articular cortex (also 3Ds = dislocation, destruction & degeneration)
Which conditions may result in neuropathic arthropathy?
- 2nd to loss of sensationand proprioception
- DM
- Alcoholism
- tabes dorsalis (syphilis breaks down body, lose reflexes)
- paralysis
- syringomyelia (esp UE): cavity inside canal filled w CSF
- Essentially severe, destructive DJD
What is synoviochondrometaplasia?
- Benign; metaplasia of hyperplastic synovium to hyaline cartilage
- cartilage ossifies, detaches → loose bodies (any synovial jt)
- large wt-bearing jts, Knee MC, st BL
- Never in spine
- Radiographic: Mult radiodense loose bodies in jt capsule, LC tendon sheath or bursae; Pressure erosions, wide jt space,
- Sx: asx, pain, jt swell, stiff, “joint locking”, crepitus, effusion, reduced motion, 2nd DJD
Name the common sites of involvement of RA in the hand & wrist:
Hands: • MCP’s & PIP’s • marginal erosions (irregular, no sclerotic margin): radial margins of 2-3 MC head • spinde digit (soft tissue swelling) • Boutonniere (DIP extend, PIP flex) • Swan neck deformities (DIP flex, PIP extend) • Ulnar deviation at MCP jt Wrist: • Ulnar Styloid erosion • uniform loss of radiocarpal jt • erosions of triquetrum-pisiform • spotty carpal sign • pancarpal involvement • scapholunate dissociation
What is a marginal erosion?
irregular, no sclerotic margin (on sides of MC heads, esp radial)
• Marginal erosions: bare area; up to 1 yr; extend to central portions
• Erosions - gout
