Diagnosis and Interpretation Flashcards
Achondroplasia findings:
Champagne glass pelvis, splayed cupped metaphysis, small skull base
Acromegaly findings:
Large sella turcica, arrowhead phalanges, heel pad >23mm, prominent EOP
Aneurysmal bone cyst findings:
Soap-bubble metaphyseal lytic lesion, filled with blood, ballooning of cortex
AS findings:
Shiny corners, Romanus lesions, dagger sign, bamboo spine
Blount findings:
Wedge shaped dense medial upper end of tibia, overweight and black kids
Chandler findings:
AVN of head of femur, patchy sclerosis and lucency, crescent sign
Chondroma findings:
Eccentric lucent lesion in metaphysis with cortical depressions
Chondroblastoma findings:
Oval epiphyseal lytic lesion in lower or upper tibia, fluffy cotton wool
Condromyxoid fibroma findings:
Round/elongated lesion eccentriclly located, thins the cortex
Chondrosarcoma findings:
Intramedullary lytic soap-bubble lesion, speckled calcification in tibia
Cushing’s syndrome findings:
Cod-fish vertebra, generalized osteoporosis, compression fractures
Enchondroma findings:
Geographic central expansile lesion w/stippled calcification, hands or feet
Enchondomatosis findings:
Numerous intramedullary lesions in long bones, phlebolith calcifications
Eosinophilic granuloma findings:
Geographic lesion in medullary region, destructive moth-eaten appearance
Ewing’s sarcoma findings:
Diaphyseal permeative, onion-skin appearance with cortical saucerization
Fibrous dysplasia findings:
Circumscribed lytic lesion, ground glass, soap-bubble, shepherd’s crook
Fibrosarcoma findings:
Lytic metaphyseal lesion extending into diaphysis, soft tissue involved
Freiberg’s disease findings:
AVN, sclerosis, fragmentation, deformation of 2nd metatarsal head
Giant cell tumor findings:
Eccentric metaphyseal lesion across epiphyseal line, soap bubble appearance
Hemangioma findings:
Osteolytic lesion, corduroy cloth, striated vertebrae, picture frame like
Hemophilia findings:
Articular irregularity, wide intercondylar femoral groove, soft tissue swelling
Kienbock findings:
AVN, dense sclerotic lunate w/partial fragmentation and collapse
Kohler findings:
AVN partial fragmentation, sclerosis and collapse of navicular bone
Lymphoma in bone findings:
Ivory vertebra, punched-out lytic lesion, bilateral hilar lymphadenopathy
Non-ossifying fibroma findings:
Solitary oval radiolucent defect thin cortex, bunch of grapes appearance
Osteitis condensans ilii findings::
Triangular sclerosis of lower ilium near SI jt, bilateral symmetrical
Osteopoikilosis findings:
Multiple small rounded radiopacities in ends of long bones
Oseoblastoma findings:
Eccentric lytic lesion in metaphysic or diaphysis or neural arch
Osteochondritis dessicans findings:
AVN medial femoral epicondyle, ankle, hip, elbow, arc-like cleft, fragment
Osteochondroma findings:
Broad-based bone outgrowth-culiflower (mushroom) or coat-hanger look
Osteoid osteoma findings:
Lecent lesion <2cm surrounded by a rim of dense bone, long bone or spine (relieved by aspirin)
Osteoma findings::
Dense sclerotic well-circumscribed lesion rarely >2cm in skull or sinuses
Osteomalacia findings::
Pseudofractures in long bones, decreased bone density, coarsened trabeculae
Osteomyelitis findings:
Soft tissue swelling, periosteal elevation, Brodie’s abscess, involucrum, teeth marks, decreased joint space
Osteosarcoma findings:
Blastic meaphyseal permeative lesion, Codman triangle, sunburst appearance
Paget’s disease findings:
Cotton wool skull, mixed blastic/lytic lesion, pelvic brim and candle flame sign, ivory vertebra, picture frame vertebra, large vertebra
Pelligrini-Stieda disease findings:
Ossification of medial knee collateral ligament - trauma
Preiser findings:
AVN sclerosis and fragmentation of proximal pole of scaphoid
Scleroderma findings:
Soft tissue retraction, calcinosis cutis, acro-osteolitis
Scurvy findings:
Frankl’s line, Pelken’s spur, Wimberger’s ring
Sever findings:
AVN fragmented irregular sclerosis of calcaneal apophysis
Simple Bone Cyst findings:
Expansile geographic defect in proximal humerus or femur, fallen fragment sign
Sprengel’s deformity findings:
Small elevated scap, omovertebral bone, Klippel Feil (blocked vertebra, occipitalization, platybasia, wasp-waist sign)
Enostoma is?
Island of bone in vertebra
syndesmophytes in AS compared to DISH/Psoriatic arthritis and Reiter’s
Thin, marginal
Thick, non-marginal, lumpy
Primary malignancy in old? young?
Multiple myeloma
Osteosarcoma
Second most common primary malignancy in the old? YOung?
Chondrosarcoma
Ewing sarcoma
Monteggia fracture findings:
Fracture of proximal ulna and dislocation of proximal radio-ulnar joint
Night stick fracture findings:
Midshaft fracture of ulna
Galeazzi fracture findings:
Fracture/dislocation through distal radius and dislocation of distal radio-ulnar joint
Anterior lunate dislocation findings:
slice of pie sign with volar orientation of lunate
Scapholunate dissociation findings:
Terry Thomas sign: increase space btw scaphoid and lunate
Madelung deformity findings:
V shaped proximal carpal row with dorsal dislocation of ulna and exaggerated deviation of hand
Basstrup’s findings:
formation of neo-arthrosis btw two adjacent spinous processes (kissing vertebra disease)
Canal stenosis findings:
relative 10-13 mm
Absolute <10mm
DISH findings:
Calcification of ALL, normal disc height, flowing anterior syndesmophytes of at least 4 vertebral bodies, dripping candle wax appearance, associated with diabetes and dysphagia
Chance fracture findings:
Horizontal fracture through neural arch and vetebral body; MC L1/2
Clay shoveler fracture findings:
through spinous of C7 - hyperflexion injury
Hangman fracture:
Through pedicle of C2
Tear drop fracture:
Avulsion fracture from anterior inferior aspect of cervical vertebra due to hyperextension injury
Hahn’s lines:
Horizontal lines for venous channels in vertebral body
Limbus bone:
Small piece of bone in line with vertebral body and round edges
Os odontoideum vs ossiculum terminale:
Gap btw base of dens and body of axis due to failure of dens to fuse w/rest of axis
Unossified growth plate btw dens and axis; normal btw 10-20 years
Spatulization refers to:
Hypertrophy of TVP of L5
Spondylolisthesis types:
I: Dysplastic/congenital
II: isthmic/pars fracture MC @L5
III: degenerative MC in females >40 @L4
IV: Trauma through neural arch
V: pathological (Paget’s, 1o/metastatic cancer)
VI: iatrogenic; related to surgical intervention
Duverny fracture findings:
Fx through lasteral aspect of iliac wing
Malgaigne fracture findings:
ipsilateral vertical fracture through superior and inferior pubic rami
Intracapsular fractures of femoral neck:
Subcapital, midcervical, basicervical
Extracapsular fractures of femoral neck:
Intertrochanteric and subtrochanteric
Otto’s pelvis findings:
Primary defect in pelvis causing inward bulge of both acetabuli
Rider’s bone findings:
Ossification of origin of tendon of adductor longus
Pott’s/Dupuytren’s/Bimalleolar fracture findings:
Distal fibular above lateral malleolus w/avulsion medial malleolus caused by severe eversion injury
Lisfranc fracture findings:
Multiple fractures just below heads of 2/3rd mets, lateral displacement of bases of 2-4th mets, increased space btw 2/3rd mets
Sinus tarsi findings:
Tunnel seen btw neck of talus and anterosuperior aspect of calcaneus
Atelectasis findings:
Consolidation, air bronchogram with tracheal deviation to affected side
Bronchopneumonia findings:
Patchy bilateral basal consolidation
Emphysema findings:
Hyperinflated lung fields, thin mediastinum, flattened diaphragm and large retrocardiac and retrosternal windows
Histoplasmosis findings:
Popcorn egg shell calcification in hilar lymph node or coin lesion in lungs
Lung abscess findings:
Round lesion w/air-fluid interface on inside
Perforated peptic ulcer findings:
Air under R dome of diaphragm (pneumoperitoneum)
Pleural effusion findings:
Obliteration or blunting of one costophrenic angle w/meniscus sign, if large may be associated w/tracheal deviation away from affected side
Pneumonia findings vs pneumocytis jiroveci pneumonia:
Segmental or basal, air bronchogram and silhouette sign
VS
ground-glass appearance of both bases
Pulmonary embolism findings:
Hampton’s hump/wedge-shape consolidation w/rounded convex apex
Sarcoidosis findings:
Bilateral hilar lymphadenopathy, diffuse pulmonary fibrosis
Tension pneumothorax findings:
Unilateral hyperinflated lung field with tracheal and mediastinal deviation away from affected side
Coin lesion in a chest film can indicate:
Histoplasmosis, TB, RA (Caplan’s lung)
Miliary calcification in a chest film can indicate:
TB, histoplasmosis, silicosis
Acute pancreatitis findings:
sentinel loop of distended small bowel
Chronic pancreatitis findings:
speckled calcification on either side of upper lumbar vertebra
PCOS findings:
String of pearls sign on US = multiple (10+) cysts btw 2-8mm in peripheral of both ovaries
Renal A calcification findings:
Cheerio sign anterior to vertebral body on lateral film
TB in psoas muscle findings:
Calcification in psoas
Volvulus findings:
Inverted U or coffee-bean sign, dilated loop of bowel filling pelvis and abdomen
Wormian bones are found in what pathologies?
Clediocranial dysostosis, osteogenesis imperfecta, Down’s syndrome
Chamberlain’s line:
Line btw posterior tip of hard palate to opisthion if dens >7mm above this line indicative of basilar impression/invagination –> RA, Down’s, Klippel Feil syndrome, Arnold Chiari malformation
McGregor’s line:
Line btw posterior tip of hard palate to base of occiput if >8mm above line in males and >10 in females indicative of basilar impression/invagination –> RA, Down’s, Klippel Feil syndrome, Arnold Chiari malformation
McRae’s line:
Line btw basion to opisthion if tip of dens is above this line indicative of basilar impression/invagination –> RA, Down’s, Klippel Feil syndrome, Arnold Chiari malformation
Cobb’s angle:
Find superior and inferior extremities of scoliosis draw parallel lines through superior and inferior endplates of vertebrae and perpendicular lines from these endplates and measure angle of intersection
<20o monitor and adjust
20-40o ortho brace
>60o possible surgery
Hadley S Curve:
ON AP Lumbar curved line along inferior margin of TVP and down along inferior articular process to facet joint space should look like an S if interruption may indicate facet imbrication (normal btw T5-T9)
Eisenstein’s method:
Measure distance btw midpoints of posterior margin of body and line connecting anterior tips of superior and inferior articular facets
<15 mm in lumbar or <13 mm in cervicals = canal stenosis
Relative btw 10-13
Absolute <10mm
Ferguson’s base of sacrum angle
Draw line through and parallel to base of sacrum draw second line parallel to bottom edge of film measure angle they intersect (26-57 avg 41) increases suggest mechanical factor in cause of LBP by increasing shearing and compressive forces on lumbosacral articulations
van Akkerveeken’s line
Lateral lumbar spine radiograph in extension draw lines through and parallel to adjacent EP until they intersect posteriorly. Measure distance btw posterior margins of bodies and point of intersection if >1.5mm difference indicative of lumbar instability
Klein’s line:
Draw line along outer margin of neck of femur should pas through head if it doesn’t SCFE
Kohler’s line:
Line connects lateral pelvic brim to outer obturator foramen floor of acetabulum shouldn’t cross if it does protrusio acetabuli –> RA, Rickets, Paget’s
Macnab’s line:
Line through and parallel to inferior EP of vertebra above if through superior articular process facet imbrication present
Meyerding’s grades:
Base of sacrum into 4 equal parts and note posterior margin of posterior L5 to measure degree of spondylo
Ulmann’s/Garland-Thomas line:
Draw parallel line which passes through base of sacrum draw perpendicular line from sacral promontory if anterior aspect of inferior part of body of L5 lies beyond this perpendicular line then spondylolisthesis is present
Mikulicz’s angle (femoral angle):
Line through middle of axis of femur and middle of axis of neck and measure angle btw these lines
120-130 normal
<120 coxa vara
>130 coxa valga
Shenton’s line:
Curvilinear line along inferior aspect of neck of femur to superior aspect of obturator foramen
If line interrupted, discontinuous then dislocation, femoral neck fracture or SCFE is present
Skinner’s Line:
Line through middle of axis of femur, horizontal line touches tip of greater trochanter if fovea capitis of head of femur lies below line femoral neck fx or coxa vara (should not be >2mm)
Bohler’s angle:
Connect three highest points on calcaneus by two lines and measure angle at which these two lines intersect: 28-40o
<28o = calcaneus fracture
Heel pad thickness:
Shortest distance btw plantar surface of calcaneus and outline of skin, normal 25 mm in males, 23 in females
if greater than this = acromegaly
