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Diagnostic Imaging > DI 2 Final > Flashcards

DI 2 Final Flashcards

1
Q

what are the three presentations/ types of osteoporosis

A
  • Generalized
  • Regional
  • Localized
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2
Q

What are the risks of generalized osteoporosis

A
  • Age related
  • Post menopausal
  • Steroid and heparin induced
  • Multiple myeloma
  • Metastasis
  • Hyperparathyroidism
  • Scurvy
  • Osteomalacia
  • Rickets
  • Sickle cell anemia
  • Osteogenesis imperfect
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3
Q

what is the cause of regional osteoporosis

A

dt disuse, immobilization, RSD (reflex sympathetic dystrophy)

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4
Q

What is the cause of localized osteoporosis

A

dt tissue inflamation arthritis neoplasm

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5
Q

what is the most common cause of generalized osteoporosis

A

increasing age

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6
Q

What is the standard imaging modality to quantify bone mineral density?

A

DEXA scan (dual energy x-ray absorptiometry)

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7
Q

Osteomalacia

A

lack of osteoid mineralization leading to generalized bone softening, bones lack a proper amount of calcium

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8
Q

Rickets

A
  • osteomalacia in kids
    -systemic skeletal disorder dt
    deficiency primarily of vit D
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9
Q

What are the classic radiographic features of rickets

A
  • Generalized osteopenia
  • Coarse trabecular changes
  • Widened growth plates
  • Rachitic (costal) rosary
  • Absent zone of provisional calcification - ( frayed ‘paintbrush’ and cupped metaphases)
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10
Q

What causes scurvy and

A
  • Scurvy: depressed intercellular substance formation, esp. in connective tissue, cartilage and bone
  • cause by Vit C deficiency
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11
Q

What are the radiographic features of scurvy

A
  • Few in adults – often just osteopenia
  • A combo of abnormalities occurring at the growing ends of long bones
  • Osteoporosis
  • Dense zone of provisional calcification (White Line of Frankel)
  • Ring epiphysis (Wimberger’s sign) circular, opaque shadow surrounding epiphyseal centers of ossification
  • Pelkan spurs – lateral growth of metaphysial calcification zone creates beak appearance
  • Scorbutic zone (Trummerfeld zone) – lucent band beneath white band of frankel
  • Subperiosteal hemorrhages (due to deficiency of intercellular cement which in turn promotes vascular fragility)
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12
Q

What are the classic radiographic features of hyperparathyroidism in the Hand

A
  • Subperiosteal resorption (hallmark feature)

- Radial margins of the proximal and middle phalanges of the 2nd and 3rd digits with acroosteolysis

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13
Q

What are the classic radiographic features of hyperparathyroidism in the Skull

A
  • “salt and pepper”

- resorption of lamina dura

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14
Q

What are the classic radiographic features of hyperparathyroidism in the Spine

A
  • Osteopenia
  • Trabecular accentuation
  • End plate concavities
  • “rugger jersey” spine
  • widened SI joints
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15
Q

What are the face, skull, and foot changes seen with acromegaly?

A
  • d.t pituitary eosinophilic adenoma secreting GH after the plates have fused
  • XS production of GH prior to the closure of the long bone growth centers = gigantism

Face:

  • Prominent forehead
  • Thickened tongue

Skull:

  • Sella turcica enlargement (dt pituitary neoplasm)
  • Sinus overgrowth
  • Malocclusion
  • Widened mandibular angle (prognathism)

Foot:
- Heel pad greater than 20 mm (approx. 1 inch)

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16
Q

what osseous changes might long term corticosteroids cause

A

cushings Dz and steroid induced osteonecrosis

  • both d.t XS glucocorticoid release by the adrenal cortex
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17
Q

Osteoporosis of cushings disease

A
  • Cortices are thinned, density diminished and deformities evident
  • Biconcave end plate configurations (differentiates from old age osteoporosis)
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18
Q

Osteonecrosis/ avascular necrosis Dt glucocorticoids

A

Seen in femoral and humeral heads, distal femoraknee) and talus

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19
Q

Intravertebral vacuum cleft sign dt glucocorticoids

A

d.t collapse of a vertebral body following steroid medication from ischemic necrosis  looks like a compression fx with wedging anteriorly and vacuum of air inside vertebral body

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20
Q

The ‘H’ shaped vertebra is classically seen in what condition

A
  • Sickle Cell Anemia
    (caused by osteoporosis of vertebral bodies – deformed at end plates with central depression due to hypoplasia of central portion of vertebrae)
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21
Q

What are some complications to the skeleton secondary to Sickle cell

A
  • Bone marrow hyperplasia, ischemia and necrosis
  • Osteopenia/osteoperosis due to marrow hyperplasia
  • Osteomyelitis – caused by salmonella in sickle cell anemia, destroys vertebrae (hematogenous spread)
  • Thin cortices (increased radiolucency)
  • Coarse trabeculae (esp in axial skeleton)
  • Large vascular channels
  • Widened medullary cavity due to marrow hyperplasia
  • Growth deformities
  • Epiphyseal ischemia necrosis = osteonecrosis = avascular necrosis
  • Medullary infarcts (metaphysis or diaphysis)
  • Vertebral body collapse
  • Posterior mediastinal extramedullary hematopoiesis (blood forming a mass next to the vertebral bodies in the T spine – may look like a lung tumor on xray)
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22
Q

Which anemia tends to result in ‘honeycomb’ trabecular patterns?

A

thalassemia

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23
Q

Hemophilic arthropathy is typical in which joints

A
  • Knee, ankle, elbow (bilateral and symmetrical) – all weight bearing joints
  • Knee will show enlarged epiphyses, widened intercondylar notch, squared inferior patella
  • Ankle may show tibiotalar slant deformity
  • Pseudotumors – destructive intraosseous hemorrhages – most commonly occur in femur and pelvis
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24
Q

What is a common ddx when encountering hemophilic arthropathy of the knee ( hint: think childhood arthritis)

A

Juvenile RA

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25
Q

List some common sites for avascular necrosis/ osteonecrosis

A
  1. epiphyses ( may remain clinically silent until articular collapse) - esp femoral head
  2. metaphases/diaphysis- usu completely asx
  3. conditions leading to Avas necrosis
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26
Q

What are some conditions that lead to avascular necrosis

A
  • Legg-Calve-Perthes Disease: avasc necrosis of femoral head
  • SONK = spontaneous osteonecrosis of the knee (collapse of articular surface)
  • Keinboch’s Disease = avascular necrosis of the carpal lunate
  • Osteochondritis Dissecans = in adolescence, small segment of subchondral bone undergoes ischemic necrosis secondary to trauma or primary vascular occlusion (most common in knee or ankle)
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27
Q

List 5 typical causes of avascular necrosis/ osteonecrosis

A
  1. Trauma
  2. Hemoglobinopathy
  3. Caisons disease (the Bends)
  4. Corticosteroids
  5. Collagen disease
  6. Radiation
  7. Alcoholism
  8. Gaucher’s disease
  9. Pancreatitis
  10. Gout
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28
Q

Which common arthritis demonstrates non-uniform joint space narrowing, osteophytes, subchondral sclerosis and subcentral cysts

A

Degenerative Joint Disease (most common joint disease)
(Also will see asymmetric distribution, joint subluxation, articular surface deformity, and intraarticular osteochondral bodies)

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29
Q

Which condition presents with a triangular sclerosis at the iliac portion of the lower sacroiliac joint?

A

Osteitis Condensans Ilii

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30
Q

Is osteitis condensans ilii more commonly unilateral or bilateral?

A

bilat

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31
Q

Is osteitis condensans ilii more commonly found in males or females?

A

females ( childbearing ge)

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32
Q

Osteitis pubis is commonly associated with which medical procedure?

A

Surgeries near the pubic symphysis

Osteitis pubis = inflammation of the pubic symphysis

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33
Q
  1. What is the difference between marginal and non-marginal syndesmophytes?
A

Syndesmophyte = osseous excrescence attached to a ligament
Non-marginal: don’t come from the corners

Marginal: ossification of outer annulus fibrosis leading to thick, vertical radiodense areas – connect adjacent vertebrae

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34
Q

Which spinal arthritides have marginal vs. non-marginal syndesmophytes?

A

Marginal: Ankylosing Spondylitis: bamboo spine, formed from extensive syndesmophwytes

Non-marginal: Psoriatic arthritis (at thoracolumbar jxn), Reiter’s syndrome  syndesmophytes skip levels with these two conditions

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35
Q

What systemic condition is commonly found in patients with diffuse idiopathic skeletal hyperostosis?

A

Diabetes (up to 50% of pts with DISH)

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36
Q

Dysphagia is common in which arthritic condition and why?

A

DISH – dysphagia due to spinal involvement, tendenous and extraspinal ligamentous calcification and ossification creates stiffness and difficulty swallowing

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37
Q

What part of the spine is DISH most commonly found?

A

Thoracic, lower cervical, upper lumbar

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38
Q

List the radiographic findings of neurotrophic arthropathy.

6 D’s

A 
Distended joint
Density increase
Debris
Dislocation
Disorganization
Destruction
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39
Q

Which conditions may result in neurotrophic arthropathy?

A
  • Diabetes
  • Alcoholism
  • Tabes dorsalis (complication of syphilis leading to muscle weakness/paresthesia)
  • Paralysis
  • Syringomyelia (damage to spinal cord dt formation of fluid-filled area within cord)
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40
Q

What is synoviochondrometaplasia?

A

Metaplastic changes in synovium produce cartilaginous bodies
These bodies may or may not ossify or calcify
They also may or may not be free within joint capsule 

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41
Q

Name the common sites of involvement of rheumatoid arthritis in the hand

A

Hands: MCPs, PIPs (not DIPs)
• spindle digit (soft tissue swelling)
• marginal erosions (irregular with no sclerotic margin) especially of the 2nd and 3rd metacarpal head
Hand Deformities:
• Boutonniere – DIP extension, PIP flexion
• Swan neck – Dip flexion, PIP extension
• Ulnar deviation at MCP joint
• Radial deviation of carpals
• Zig-zag deformity – ulnar deviation and radial deviation

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42
Q

Name the common sites of involvement of rheumatoid arthritis in the wrist.

A 
often occurs earlier and more severe than hand changes
•	ulnar styloid erosion
•	uniform loss of radiocarpal joint
•	erosions at triquetrum-pisiform
•	“spotty carpal” sign
•	pancarpal involvement
•	scapholunate dissociation
43
Q

What is a marginal erosion and what category of arthritis is it seen with?

A
  • Seen in rheumatoid arthritis, especially in the radial margins of the 2nd and 3rd MC heads
  • Irregular erosion with no sclerotic margin
44
Q

What is the significance of widening of the atlantodental interspace?
Seen in R.A.:

A

• can create direct compression of the brainstem or cause neurological damage by creating excessive kyphosis
• can create C1-C2 instability  neurological damage, atlanto-axial subluxations
can get anterior-lysthesis if facet involvement: stair-stepping

45
Q

Which conditions demonstrate laxity of the transverse ligament?

A

SLE, Down’s syndrome, possible with RA (but uncommon): The inflammatory arthridities tend to affect the tendons and ligaments rather than joint membranes

46
Q

Is sacroiliac involvement common in rheumatoid arthritis?

A

No – if so, minimal sclerosis, unilateral or bilateral asymmetric

47
Q

describe how psoriatic arthritis effects the hands

A
  • DIPs and PIPs
  • All three joints in a single digit involved = “ray pattern”
  • Pencil-in-cup deformity (narrowing/tapering of middle bone like a pencil, with cup shaped distortion in end bone)
  • Asymmetric
  • Pseudowidening
  • Osseous fusion
  • Acro-osteolysis (see question 31)
48
Q

How does Psoriatic arthritis effect the body in general

A 
•	Asymmetric
•	Soft tissue swelling
•	No osteopenia (unlike RA)
•	Erosions
•	Fluffy periostitis
•	Narrowed or widened jt spaces
ankylosis
49
Q

How for RA Fx the hands

A
  • MCPs and PIPs (not DIPs)
  • Soft tissue swelling (spindle digit)
  • Marginal erosions (irregular with no sclerotic margins)
  • Radial margins of 2nd and 3rd MC head eroded
  • Boutonniere – DIP ext, PIP flex
  • Swan neck – DIP flex, PIP ext
  • Ulnar deviation at MCP
  • Radial deviation of carpals
  • “Zigzag” deformity: ulnar + radial deviation
50
Q

How does RA affect the Wrist

A 
•	often earlier and more severe than hand changes
•	ulnar styloid erosion
•	uniform loss of radiocarpal joint
•	erosions at triquetrum-pisiform
•	“spotty carpal” sign
•	pancarpal involvement
scapholunate dissociation
51
Q

What is the incidence of RA

A

F:M 3:1 until 40, then 1:1

52
Q

What is the first site of involvement with ankylosing spondylitis

A
  • most classic finding
  • bilateral, symmetric
  • changes more prominent on iliac side and lower 2/3
  • pseudowidening  erosions (“rosary bead” appearance)  reactive sclerosis  ankylosis (average 14 years)
  • approximately ½  ankylosis
  • similar changes occur at pubic symphysis
53
Q

What is the second site of involvement with ankylosing spondylitis

A

Spine – discovertebral joint (outer fibers of annulus erode  sclerose  ossify)
Also apophyseal joints, interspinous ligament ossification, costovertebral joints, cervical spine involved

54
Q

Is SI invoement usually unilateral or bilateral in ankylosing spondylitis

A

bilateral

55
Q

What isteh incidence of ankylosing spondylitis

A

younger males (15-35) M:F 9-1

56
Q

Which condition demonstrates acquiring of the vertebral body?

A

ankylosing spondylitis

57
Q

What is the shiny corner sign

A

increased radio density of vertebral body related to osteitis in (AS)

58
Q

What is a carrot stick fracture?

A

A complication of ankylosing spondylitis, a fracture of an alkylosed segment of vertebrae, usually causing paralysis 

59
Q

Which condition demonstrates similar sacroiliac joint and vertebral column findings to ankylosing spondylitis?

A

Enteropathic arthropathy, secondary to ulcerative colitis, crohn’s dz, whipple’s dz, salmonella, shigella, Yersinia\

60
Q

Which two seronegative spondyloarthropathies demonstrated non-marginal syndesmophwytes and peripheral arthritis

A

Psoriatic and Reiters

Non- marginal syndesmophytes= thicker, not throughout the spine like in AS

61
Q

Reversible deformities of the hand are seen in which condition?

A
  • Systemic Lupus Erythematous (SLE)
  • ulnar deviation, but pt can overcome this with muscle contraction or pushing down on the table
  • ligaments are lax, but joints are not destroyed
62
Q

What is acro-osteolysis and which conditions demonstrates this finding?

A

resorption of the extremities (ie, distal phalanx “tufts”)

seen in scleroderma, psoriatic, SLE, hyperparathyroid

63
Q

What is the overhanging margin sign and which condition is this seen in ?

A

Pathognomonic finding in Gout, a C-shaped erosion that sticks out 

64
Q

What structures are primarily involved in CPPD?

A

CPPD = Calcium pyrophosphate dihydrate crystal deposition dz)
- wrist, triangular fibrocartilage distal to ulnar styloid
- knee, meniscus
- pubic symphysis
- involves calcification of cartilage  chondrocalcinosis in intermediate layer
- fibrous & hyaline cartilage
- fibrous in meniscus and triangle
- hyaline at end of bones: calcification parallel to cortex, thin, linear
• AKA pseudogout
• onset after 30, peaks at 60
• Dx’ed by aspiration of synovial fluid

65
Q

What structures are primarily involved in HADD?

A

HADD = Hydroxyapatite deposition disease
Common at shoulder and hip
Usually a single site of involvement
Causes calcific tendinitis (bursae, ligament, capsule)

66
Q

What is the most common source of osteoblastic metastatic carcinoma in adult females?

A

breast cancer

67
Q

List the 3 common causes of solitary sclerotic vertebral body/ ivory vertebra

A

Hodgkin’s lymphoma (anterior scalloping)

Osteoblastic mets

Paget’s disease – cortical thickening and expansion

“hop”

68
Q

Is it common to find a tumor involving a joint

A

nope

69
Q

Is multiple myeloma more common in a vertebral body of neural arch?

A

vertebral body

70
Q

What malignancy demonstrated as a cold bone scan

A

multiple myeloma

71
Q

Which is the most dense (white on x-ray) primary malignant bone tumor?

A

Osteosarcoma (2nd most common primary malignant bone neoplasm

72
Q

What is the common age range of primary osteosarcoma

A

10-25 years old

- in older pts, likely dt malignant degeneration of benign process

73
Q

What is the difference between sunburst and onion skin appearance?

A

Sunburst – seen in hemangioma, lytic skull lesions with striations in a “sunburst” or “spoked wheel” pattern 

74
Q

Onion skin

A
  • layered or laminated periosteal rxn created by several parallel concentric layers or lamellae of periosteal new bone
  • implies a more aggressive process, but can be dt both benign and malignant conditions
  • most characteristic of Ewing’s sarcoma but could be found in osteosarcoma, osteomyelitis, stress fxs, eosinophilic granulomas in very young pts
75
Q

Which part of the long bone is commonly involved in osteosarcoma?

A

Metaphysis – especially in distal femur, proximal tibia and proximal humerus

76
Q

What is codman’s triangle?

A

When the periosteum lifts off of the cortex, creating triangular layers that form at the margin of the lesion, often in osteosarcomas (also seen in osteomyelitis)
the triangle itself is usu tumor free

77
Q

Why is Ewing’s sarcoma commonly found in the diaphysis of long bone?

A

Why is Ewing’s sarcoma commonly found in the diaphysis of long bone?

78
Q

• What is a geographic lytic appearance and does it suggest more benign or aggressive neoplasms?

What are the other two lytic appearances of tumors?

A
  1. Geographic lytic appearance = confined to a relatively specific area that is more or less easily defined, more likely to be benign (see left)
  2. Moth eaten and
    Permeative
79
Q

Which condition presents as a solitary exostosis that points away from the nearest joint?

A

Osteochondroma

80
Q

Compare the incidence of malignant transformation in osteochondroma and hereditary multiple exostosis.

A

Osteochondroma: malignant degeneration in 1% (solitary)

Hereditary Multiple Exostosis: 20% malignant degeneration

81
Q

What is a “corduroy vertebra”?

A

Corduroy cloth appearance of vertebrae, seen in hemangioma due to lytic lesions with coarse vertical striations

82
Q

Is spinal hemangioma commonly solitary or polyostotic?

A

Solitary

83
Q

Which is the most common benign bone tumor of the spine?

A

hemangioma

84
Q

hemangioma

A
  • age 40 and up
  • usually asx – can have pain or muscle spasm occasionally
  • neurological compromise due to ballooning of vertebral body, extension of tumor into central canal, pathologic fx, hemorrhage
  • 75% found in spine and skull
  • usually in vertebral body, 10-15% into arch
  • usually solitary
  • body expansion is rare
85
Q

bone island

A

AKA: Enostoma

  • Usually asymptomatic
  • Occurs in pelvis, sacrum, proximal femur, and any bone except skull
  • compact lamellar bone in spongiosa
  • can look like blastic mets on an xray
86
Q

Which benign tumor classically demonstrates as pain worst at night and easily relieved by aspirin?

A
  • pain refers to nearby joint
  • usually in kids
  • can cause painful, rigid scoliosis
  • can occur in any bone (50% in femur and tibia, 20% phalanges, 10% spine)
  • tends to be in cortex of bone
87
Q

Which part of the bone is usually involved with osteoid osteoma?

A

cortex, will see increased opacity on X-ray, actual lesion is lucent ( but usu

88
Q

What is the appearance of the tumor metric in enchondroma?

A 
Cartilaginous lesion inside the cartilage 
•	thinned cortex
•	endosteal scalloping
•	stippled calcification
Asx, but can cause pathologic fx 
Age 10-30
Can happen in any bone with cartilage
Most common tumor of phalanges
Can potentially transform to chondrosarcoma (think pain – if no pain, likely benign)
89
Q

what is multiple endochromatosis called

A

2 types:

  1. Ollier’s Disease
    - usually unilateral, monomelic (may cause growth change, shortened limb)
    - malignant transformation rate 25-50%
  2. Maffucci’s syndrome
    - soft tissue hemangioma
    - phleboliths
    - greater risk of malignant transformation than Ollier’s
90
Q

What is the most common location of fibrous cortical defect?

A

In cortex of bone in lower extremity: tibia or fibula, also humerus, ribs, ilium
2-8 years old

91
Q

What is a fallen fragment sign also with?

A

Simple bone cyst

92
Q

What is a fallen fragment

A

piece of cortex falls off into cyst and sinks to bottom

93
Q

Which benign bone tumor is named according to its appearance rather than its histological composition?

A

Aneurysmal Bone Cyst – cystic, blood filled cavity, “aneurysmal” dt appearance 

94
Q

Describe the radiographic difference between an enchondroma, simple bone cyst, aneurysmal bone cyst and osteochondroma.

A

see def

95
Q

Endocondroma

A
  • Geographic lytic
  • Expansile
  • Thinned cortex, endosteal scalloping
  • Metaphyseal-diaphyseal
  • Most central
  • Calcification in 50%
  • No periosteal rxn, no soft tissue mass
96
Q

Simple bone cyst

A
  • Ages 3-4
  • Asx
  • 2/3 undergo pathologic fx
  • fluid-filled cyst
  • 75% in proximal humerus or femur
  • “fallen fragment” sign with fracture – piece of cortex falls into cyst and sinks to bottom of it
97
Q

Aneurysmal bone cyst

A 
•	expansile
•	lytic, septated
•	eccentric
•	markedly thinned cortex
•	metaphyseal, may extend to epiphysis (only benign tumor to cross growth plate)
periosteal response more common
98
Q

Osteochondroma

A

• bony exostosis: cortex continuous with host bone; normal trabeculae
• cartilaginous cap may calcify
• project away from joint
• sessile produces asymmetric widening

• Is giant cell tumor painful? Is it malignant? 
Painful
“quasimalignant” – 20% malignant, 80% benign

99
Q

Is page’s disease monostotic or polyostotic

A

polyostotic ( Rt side more common than LF)

100
Q

List the radiographic features of Paget’s disease in a long bone such as the femur or tibia.

A

In Long bones – thickened cortex, bowing deformities (saber shin = shin that looks like a curved sword), shephard’s crook deformity = thickening of cortex plus bowing, blade of grass (candle flame or V-shape) – looks like cut piece of grass or tip of flame (lytic appearance)

101
Q

Radiographic findings in skull- pagets

A

• osteoporosis circumscripta (circumscribed, outlined lytic area ), cotton wool appearance (spots all over skull)

102
Q

Radiographic findings in jaw, spine, pubic bone- pagets

A
  1. increased size
  2. Ivory vertebrae, picture frame vertebra ( thickened cortex)
  3. unilateral “brim sign”- thicker on one side than the other
103
Q

Pagets Dz in general - radiographic sx

A
  • increased or decreased bone density
  • coarsened less distinct, trabeculae
  • thickened cortex (less distinct)
  • bone expansion
  • subarticular extension
  • pseudofractures (similar to insufficiency stress fx)
  • deformities (like bowing)
  • pathologic fx (mild trauma cuases bone to break)
104
Q

Pagets dz general info

A
  • rare before age 40, usually over 55
  • mostly asx, found incidentally on xray of low back
  • most common sx: dull, boring pain
  • temperature of involved area may increase
  • see enlargement of bone – causes mass effect on surrounding structures
  • can have heart problems bc vascular lesions – cause heart to work harder

Diagnostic Imaging (4 decks)

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