DI II Final Flashcards
What are characteristics of senile/generalized osteoporosis?
- increased radiolucency
- cortical thinning
- white endplates
- schmorls nodes
What are characteristics of regional osteoporosis?
- due to immobilization, dystrophy
- acute and painful
- osseous hyperemia
- patchy
Localized osteoporosis?
due to infection, inflammatory arthritis, neoplasm
Most common cause of osteoporosis?
age
- lack of estrogen
Imaging modality for osteoporosis?
DEXA scan
What causes rickets and osteomalacia?
vit D deficiency
malabsorption
too much Calciu, phosphorus,
Radiographic features of rickets?
- Bowing: generalized osteopenia
- wide growth plates
- rachitic rosary
- frayed paintbrush ends
What causes fish shaped vertebrae?
Cushings
radiographic findings of scurvy?
- white line of frankel
- Pelken spurs
radiographic features of hyperperathyroid
subperiosteal resorption
salt and pepper resorption of skull
osteopenia of hand
rugger jersey spin
face, foot, skull changes with acromegaly?
face: prominent forehead sinus overgrowth skull: sell trusica enlargement malocclusion foot: heel pad greater than 20 mm
The H-shaped vertebrae is classically seen in what condition?
sickle cell anemia
Complications to skeleton secondary to sickly cell anemia?
osteoporosis
large vascular channels
medullary infarcts
which anemia results in honeycombed trabecular patterns?
thalessemia
hemophilic arthropathy occurs in which joints?
knee, ankle, elbow
What is DDX of hemophilic arthropathy?
RA
What is most common form of osteoblastic metastatic carcinoma in adult females?
Breast CA
List 3 common causes of solitary sclerotic vertebral body?
- hodgkins lymphoma
- osteoblastic metastatic (most common)
- paget’s disease
Is it common to find a tumor involving a joint?
No, think arthritic disease before tumor
Is multibple myeloma more common in vertebral body or neural arch?
Vertebral body
What malignancy demonstrates a cold bone scan?
multiple myeloma
- cold bone scan = normal
- differentiate MM from mets
Which is most dense primary malignant bone tumor?
Multiple Myeloma
What is common age range of primary osteosarcoma?
10-25
Where do you see sunburst lesions?
skull hemangiomas
osteosarcoma
lytic with striations
bad
where do you see onion skin appearance?
Ewing’s tumor
layering
more aggressive process
in bening and malignant
What part of bone is involved in osteosarcoma?
metaphysics of long bone
- distal femur, proximal tibia, proximal humerus
What is codman’s triangle
triangle of layers of periosteal reaction form at margin of lesion
- area formed under growth of tumor
- not a good place to biopsy because benign area
- in bone sarcomas and osteomyelitis
Why is Ewing’s sarcoma commonly found in diaphysis of long bone?
arises from bone marrow which is in diaphysis
What is geographic appearance?
confined to specific area
usually benign
which condition presents with solitary exostosis that points away from nearest joint?
osteochondroma
What is radiographic difference in appearance between osteochondroma and benign solitary expansile osteolysis?
osteochondroma: bony exostosis
- away from joint
- pedunculated or sessile
benign solitary expansile: large
- lytic and separated
- thin cortex
- only tumor to cross growthplate
compare incidence of osteochondroma and hereditary multiple exostosis
osteochondroma: 1% malignant trans
HME: 20% malig trans
What is corduroy vertebra?
lytic lesion with coarse vertical striations
in hemangiomas
Spinal hemangioma soitary or polyostotic?
solitary
which is most common benign bone tumor of spine?
hemangioma
is a bone island symptomatic?
No, except in skull
Which condition demonstrates pain worst at night and relieved by aspirin?
Osteoid osteoma
Which part of bone is in osteoid osteoma?
any, but cortical most common (tibia, femur)
What is an enchondroma and what is the matrix appearance in an enchondroma?
a cartilage cyst found in bone marrow
- originates form cartilage
- matrix = stippled scalloping
Why is it common to observe short limb with enchondroma?
most common tumor of hand and feet
tumor effects limbs
What is multiple enchondromatosis called?
Ollier’s Disease
What is most common location for fibrous cortical defect?
lower extremity in tibia or fibula
What is fallen fragment sign?
in simple bone cysts that undergo pathologic fractures
Which benign bone tumor is named according to appearance?
aneurysmal bone cyst
radiographic features of enchondroma
small round/oval cystic defects
stippled matrix
discrete islands of cartilage surrounded by layers of bone
radiographic features of simple bone cyst
oblong expansile central radiolucent lesion fallen fragment sign
radiographic features of aneurysmal bone cyst
osteolytic with soap bubble appearance
expansile
radiographic features of osteochondroma
sessile or pedunculated
coat hanger exostosis
cauliflower exostosis
Is Page’ts disease monostotic or polystotic?
polystotic (more than one bone involved)
5 radiographic features of pagets disease
- coarsened trabeculae
- thickened cortex
- bone expansion
- subarticluar expansion
- deformities
Which condition demonstrates nonuniform joint space narrowing, osteophytes, subchondral sclerosis, and 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 unilateral or bilat?
- more common in men or women?
- bilateral and symmetrical slerosis
- common in women
Osteitis pubis is commonly associated with which medical procedure?
surgery near pubic symphysis
Difference between marginal and non-marginal syndesmophytes?
non-marginal don’t come from corners, thicker, not throughout the spine
- ex: Reiters and psoriatic
marginal is of outer annulus fibrosis leading to thick, vertical radio dense areas
- AS
Which spinal arthritides have marginal vs non-marginal syndesmophytes?
Marginal: AS
Non-marginal: psoriatic arthritis, Reiters Syndrome
What systemic condition is commonly found in pts with diffuse idiopathic skeletal hyperostosis (DISH)
diabetes
dyslipidemia
hyperuricemia
Dysphagia is common in which arthritic condition and why?
DISH because spinal involvement
- trouble swallowing if involves ALL
Intervertebral disc degeneration
- aka sponylosis
- loss of disc height
- osteophytes
- endplate sclerosis
- retrolisthesis
What part of the spine is DISH most commonly found in?
Cervical?
What are the radiographic findings of neurotrohpic arthropathy?
- joint changes secondary to loss of sensation hypertrophic type - Distended joint - Density increases subchondral bone - debris or loose bodies - dislocation - disorganization - destruction of articular cortex
atrophic type
complete resorption of articulationg bone end
- tapers bone end to sharp pont
Which condition can result in neurotrophic arthropathy?
DM
alcoholism
tabes dorsalis
paralysis
What is synoviochondrometaplasia?
benign disorder marked by metaplasia of hyper plastic synovium to hyaline cartilage.
- hyaline cartilage calcifies or ossifies and detaches from synovium to form loose bodies within joint, tendon, sheath or bursar
Where is synoviochondrometaplasia most common?
knee
never spine
What does synoviochondrometaplasia look like radiographically?
multiple radiodense loose bodies in joint capsule
widened joint space
Name the common sites of involvement of RA in the hand and wrist?
Hands: MCPs and PIPs radial margins of 2nd and 3rd MC head Wrist: ulnar styloid erosion uniform loss of radio carpal joint erosions of triquetrum
What is marginal erosion?
irregular and no sclerotic margin
bare area
What is significance of widening of atlanto-dental interspace?
can lead to direct compression of brainstem or cause neuro damage and excessive kyphosis
Which conditions demonstrate laxity of the transverse ligament?
inflammatory arthritides
SLE, Down’s
Is SI involvement common in RA?
No
Describe the radiographic findings of PA
psoriatic looks similar to RA without hyperemia
PA: DIP and PIP of hand
- ray pattern
- ST swelling
- pencil in cup deformity
- asymmetrical with uniform joint space loss
Describe the radiographic findings of RA
MCPs and PIPs
- radial margins of 2nd and 3rd MC head
- boutonniere
- swan neck deformities
- ulnar deviation of MCP joint
- bilateral and symmetrical and uniform joint loss
What is gender incidence of vertebral column and pelvis in ankylosing spondlytis?
male 9:1 onset 20-60
What is 1st site of involvement of vertebral column and pelvis in AS?
pelvis: iliac side and lower 2/3 synovial of SI joint
spine: thoracolumbar jxn
What is 2nd site of involvement of vertebral column and pelvis in AS?
column and pelvis in AS
Is SI involvement unilateral or bilateral in AS?
bilateral and symmetrical
What condition demonstrates squaring of vertebral bodies?
AS
What is shiny corner sx?
increased radio density of corners of vertebral body related to osteitis
What is a carrot stick fracture?
fracture of any anklosed segment in AS
- usually causes paralysis
Which condition demonstrates similar SI joint and vertebral column findings to AS?
Enteropathic arthropathy, UC, Crohns
Which 2 seronegative spondyloarthropathis demonstrate non-marginal syndesmophytes and peripheral arthritis?
Psoriatic and Reiters
Reversible deformities of the hand are seen in which condition?
Systemic Lupus Erythmatous (SLE)
What is acro-osteolysis and which condition demonstrates this finding?
psoriatic arthritis and resorption of extremeties
What is the overhanging margin sign and which condition is this seen in?
pathopneumonic finding in gout.
-slerotic margin outside joint capsule
What structures are primarily involved in CPPD?
knee, wrist, pubic symphysis
What structures are involved in HADD?
Shoulder and Hip
