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Fourth Year > Diagnostic Imaging > Flashcards

Diagnostic Imaging Flashcards

1
Q

5 radio opacities

A

Air
Fat
Fluid (soft tissue)
Mineral (bone)
Metal

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2
Q

What colour is radio opaque

A

White

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3
Q

What happens to a structure furhter away from the imaging plate?

A

It is magnified

Structures closer to cassette appear smaller than those further away (like a hand in a shadow)

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4
Q

What colour is positive and negative summation?

A

Positive -> white, two soft tissue opacities = thicker and more opaque

Negative -> two gas opacities become darker

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5
Q

What is border effacement? **

A

AKA negative silhouette sign

Two structures with same opacity next to each other result in loss of border

Eg right middle lung lobe with soft tissue opacity due to fluid or abscess effacing border of the heart

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6
Q

What is border enhancement?

A

AKA positive silhouette sign

Silhouette of adjacent objects of the same opacity is enhanced when surrounded by a different tissue opacity (eg in a pneumothorax the heart looks more defined)

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7
Q

What is PLACE used for?

A

To assess quality

  1. Positioning
  2. Labelling
  3. Artifacts
  4. Collimation and centering
  5. Exposure
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8
Q

7 descriptive factors to describe abnormalities: (roentgen signs)

A

Size
Shape
Location/position
Margination
Number
Opacity
Function

SSLMNOF

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9
Q

What is a radiological diagnosis?

A

Diagnosis that can be made from 1 radiograph alone with no other info

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10
Q

What are the 7 possibilities for differential diagnosis?

A

DAMNITV

Degenerative
Anomalous/acquired
Metabolic
Neoplastic
Infectious, inflammatory, immune
Traumatic
Vascular

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11
Q

Steps to write a rad report

A
  1. Identify case - name, species, maturity
  2. Identify all views taken
  3. Evaluate radiographic quality
  4. Describe all radiographic abnormalites
  5. Conclusion (list radiologic diagnosis, list prioritised differential diagnosis)
  6. Consider further imaging procedures that would be of value
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12
Q

What is a bias error?

A

Expecting to find something

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13
Q

What is a searching error?

A

Not being systematic and thorough
Over reliance on pattern recognition

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14
Q

What is a recognition error?

A

Abnormalities recognised but given too much weight or not taken into account causing a misinterpretation of results

Over or under reading

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15
Q

What is a decision making error?

A

Which abnormalities are assumed to be important

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16
Q

What is an egocentric error?

A

Overestimating your personal grasp of the truth

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17
Q

How many orthogonal views should be taken?

A

Minimum of 2

eg ML and CrCd

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18
Q

What should radiographs of long bones include?

A

Proximal and distal adjacent joints

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19
Q

What should views of joints include?

A

1/3 of bone above and below

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20
Q

What is the epiphysis?

A

Top or end of the bone

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21
Q

What is the metaphysis?

A

Just below epiphysis

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22
Q

What is the diaphysis?

A

Whole central part of bone

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23
Q

What is the physis?

A

growth plate - primary centre for ossification

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24
Q

What is the apophysis?

A

Part of bone with physis, but unlike epiphysis does not have a joint

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25
Q

What is the periosteum?

A

Membrane covering the outside of the bone

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26
Q

Endosteum

A

Membrane on the inner part of the bone

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27
Q

Trabeculae

A

Small fine lines on the ends of bones

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28
Q

What is intramembraneous ossification?

A

Ossification in fibrous tissue -> flat bones, skull and most facial bones

Mesenchymal tissue replaced by bone

Ossifies in embryo -> diaphysis then epiphysis

Periosteum produces bone by intramembranous ossification

Grow in length on the metaphysial side

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29
Q

What is endocondral ossification?

A

Ossification of preformed cartilage frame (cartilage replaced by bone)
Typical long bone has 3 centres of ossification
1. Diaphysis (primary centre)
2. Epiphysis (secondary ossification centres)

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30
Q

What side of the physis do we see increased bone opacity?

A

Metaphyseal side

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31
Q

Primary centre of ossification

A

Diaphysis - growing and lengthening

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32
Q

Secondary centres of ossification

A

Epiphysis -> bone length
Apophysis -> bone shape

Small bones -> carpi, tarsi

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33
Q

Accessory centres of ossification

A

Sesamoid bones
Focal areas of mineralisation near joints

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34
Q

What are sesamoid bones? What do they lack?

A

Small smooth rounded structures formed where tendons pass over a joint to reduce friction, protect and stabilse a tendon

Usually one one surface is articular

Lacks a periosteum

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35
Q

Where are accessory ossification centres (ossicles) normally found?

A

Many locations usually near joints or embedded in joint capsule

Generally represent normal variants that need to be differentiated from pathology

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36
Q

Examples of an accessory ossification centre

A

Accessory caudal glenoid ossification centre -> Found in medium-large breed dogs and failure to unite can cause pain

Clavicles -> ossified in 96% large dogs and all cats

Pelvis -> acetabular rim craniodorsal margin may not fuse completely

Os penis -> usually 1 but can develop 2+ centres

Coronoid process - incomplete ossification associated with elbow dysplasia

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37
Q

2 normal radiographic features of bone

A

Nutrient foraminae -> in all long bones, location of major blood vessels and nerves supplying medulla

Mach lines -> 2 cortical surfaces are superimposed causing optical illusion of a radiolucent line

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38
Q

2 types of joints

A

Synarthroses - not synovial (immovable joints like teeth to mandible)

Diarthrosis - synovial (freely moveable like elbow, ankle, knee)

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39
Q

4 Standard projections for joints

A
  1. Craniocaudal
  2. Caudocranial
  3. Mediolateral
  4. CrMCdLO (craniomedial caudolateral oblique or CrLCdMO

Flexed or extended, with traction or torsion

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40
Q

What is stress radiography for joints?

A

Applying force like compression, rotation, traction, shear and wedge

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41
Q

What is 5 alternative imaging for joints?

A

Arthrography

Ultrasound

MRI

Contrast athrography - inject contrast medium to see cartilage joint (invasive hole in joint)

Computed tomography

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42
Q

What does increased opacity indicate?

A

Productive or sclerotic changes

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43
Q

What does decreased opacity indicate?

A

Osteolysis or osteoporosis

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44
Q

5 ways bones react to disease

A
  1. Increased opacity
  2. Decreased opacity
  3. Periosteal reaction (new bone)
  4. Change in size or contour
  5. Change in trabecular pattern
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45
Q

What is Wolff’s law?

A

Bone responds to stresses placed on bone -> osteoblast and clast activity

Remodelling
- Periosteal, cortical, subchondral, endosteal and cancellous

Endosteum -> lines medulla inside bone
Periosteum -> Lines outside

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46
Q

ABCDS for musculoskeletal evaluation

A

Alignment
Bones
Cartilage
Devices
Soft tissue

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47
Q

ABCDS -> alignment

A

Describe distal part relative to proximal part
eg Lateral displacment of antebrachium relative to the humerus

Antibrachium - region from wrist to elbow

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48
Q

ABCDS -> bone

Response of bone is limited to:

A

Response of bone is limited to:

  1. Increased radio-opacity -> Sclerosis - increased density of bone OR apparent sclerosis (superimposition of bones)
  2. Decreased radio-opacity -> seen after 7-10d. Osteomalacia (poor quality good quantity), osteopaenia (good quality, poor quantity) or osteolysis (abnormal focal area of bone resorption)
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49
Q

4 Roentgen signs of osteopaenia

A

Reduced bone opacity
Cortical thinning
Coarse trabeculae
Loss of lamina dura around teeth

good quality, bad quantity of bone

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50
Q

In a diseased bone what is the usual response with decreased radio opacity?

A

Combination of lysis and sclerosis

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51
Q

Aggressiveness of bone lesion determined by looking at:

A

Location and distribution
Presence of cortical disruption
Pattern of lysis and production
Type of periosteal reaction
Rate of change of lesion
Zone of transition

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52
Q

4 Factors involved in assessing location of lesion

A

General or diffuse -> metabolic or nutritional
Whole limb -> disuse atrophy or neuropathy
Focal or multifocal
Symmetrical

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53
Q

Monostotic vs polystotic lesions

A

Monostotic -> primary bone tumours occur principally in the metaphyseal area. Can be cancerous or not cancerous

Polostotic -> metastatic tumours often more than one bone involved usually within diaphysis. Spread from elsewhere to bone

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54
Q

Signs of cortical involvement

A
  1. Thickened cortex
  2. Thinned cortex
  3. Broken cortex

If no cortical involvment -> likely benign

Look at both endosteal surfaces and periosteal

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55
Q

3 bone lysis patterns from least to most aggressive

A
  1. Geographic
  2. Moth eaten
  3. Permeative
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56
Q

Describe geographic lysis

A

Uniformly destroyed with defined border

Well demarcated, cortex expanded but not lytic

Often benign

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57
Q

Describe moth eaten lysis and 3 things it could be caused by

A

Ragged borders, multiple areas of lysis 3-10mm in size

Cortex irregularly eroded

Bone tumours, multiple myeloma and osteomyelitis

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58
Q

Describe permeative lysis

A

ill defined and spreading through marrow space

multiple pinpoint areas of lysis, cortex irregularly eroded

most agressive

Most likely bone tumour

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59
Q

Name 6 continuous periosteal reactions

A

Smooth and solid
Codmans triangle
Rough and solid
Lamellar
Brush border
Pallisading

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60
Q

Name 3 interrupted periosteal reactions

A

Spicular
Sunburst
Amorphous

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61
Q

Causes of lamellar periosteal reaction

A

Single layer of new bone
Onion skin -> trauma, infection

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62
Q

Which type of periosteal reaction is associated with malignancy?

A

Amorphous periosteal reaction

Random deposition of new bone in soft tissue adjacent to lesions

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63
Q

What is codmans triangle?

A

Occur when bone lesions are so aggressive the periosteum is lifted off the bone

Triangular cuff at edge of aggressive lesion formed due to periosteal elevation

Caused by anything that lifts periosteum off the cortex both benign and aggressive - haematoma or fracture

Not pathognomonic for a tumour

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64
Q

How long do destructive and productive changes take to be seen on radiograph?

A

Destructive -> 5-7d to be seen
Productive -> 10-14d to be seen

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65
Q

What is a transition zone and what does it mean if it is abrupt or indistinct?

A

Appearance of region between lesions and adjacent normal bone

Short and abrupt -> benign

Indistinct -> aggressive

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66
Q

4 Features of benign lesions

A
  1. Well defined border
  2. Lack of soft tissue mass
  3. Solid periosteal reaction
  4. Geographic bone destruction
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67
Q

4 features of malignant lesions

A
  1. Interrupted periosteal reaction
  2. Moth eaten or permeative destruction
  3. Soft tissue mass
  4. Wide zone of transition
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68
Q

What density is cartilage?

A

Soft tissue density -> cannot see it on radiographs clearly

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69
Q

How do we assess cartilage on radiographs?

A

Soft tissue changes -> opacity changes, swellings, atrophy

Subchondral bone destruction or sclerosis

Narrowing of joint spaces, intra-articular fractures

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70
Q

3 causes of gas opacity changes

A
  1. Laceration
  2. Gas producing organism
  3. Iatrogenic
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71
Q

3 causes of mineralisation

A
  1. Dystrophic
  2. Metastatic
  3. Neoplastic
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72
Q

3 causes of opacity changes

A
  1. Gas
  2. Mineralisation
  3. Foreign material
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73
Q

2 causes of enlargments in soft tissue

A
  1. Intracapsular soft tissue swelling -> centred on a joint, soft tissue opacity effusion
  2. Extracapsular soft tissue swelling -> away from joint or extends beyond joint, may obscure intra-capsular swelling
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74
Q

What are 2 tell tale aggressive locations?

A

Metaphyseal (primary bone tumour)

Diaphyseal (metastatic bone tumours)

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75
Q

What does it suggest if the cortex is broken?

A

Aggression

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76
Q

What would the zone of transition be like in an aggressive lesion?

A

Indistinct, permeative, long zone of transition

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77
Q

What would the zone of transition be like in a non-aggressive lesion?

A

Sharp, distinctive short zone of transition

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78
Q

4 periosteal reactions suggesting an aggressive lesion

A

Indistinct, permeative, spiculated, amorphous

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79
Q

Periosteal reaction suggesting a non-aggressive lesion

A

Smooth continuous

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80
Q

4 bones in the carpus

A

Radiocarpal bone
Intermediate
Ulnar
Accessory

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81
Q

What is horizontal beam radiography used for?

A

To see gas or fluid in the peritoneum

If the animal is in pain to keep them still

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82
Q

What is stress radiography good for?

A

Aids in joint laxity
Limb is stabilised above and below join or other area of interest

Force is applied to joint and instability shown

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83
Q

Standard views of the scapula

A

Le to Rt Lateral
CdCr

May need two laterals: body and neck of scapula

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84
Q

Shoulder joint / scapula neck standard views

A

ML
CdCr

Optional: Flexed ML, CrCd or skyline (CrPrCrDiO)

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85
Q

3 ligaments attaching to shoulder joint

A

Biceps brachii tendon
Transverse humeral ligament (medial)
Glenohumeral ligaments (medial and lateral)

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86
Q

What is a skyline image?

A

CrPrCrDiO

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87
Q

Standard views of the humerus

A

ML
CdCr

Include proximal and distal joints in

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88
Q

Standard views of the elbow

A

ML
Flexed ML
CrCd

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89
Q

Special views of the elbow

A

Cr15degreesL - CdMO for a fragmented medial coronoid process and shows medial humeral condyle

Cr15degreesM-CdLO for incomplete ossification humeral condyle fissures

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90
Q

Elbow ligaments

A

Lateral and medial collateral ligaments
Annular ligament of radius
Flexor carpi ulnaris

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91
Q

Cr15degreesL-CdMO view of elbow benefit

A

Improve visibility of medial coronoid process and medial humeral condyle

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92
Q

Standard views of the carpus

A

DPa
ML

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93
Q

Special views of the carpus

A

Flexed ML
Stressed extended
Obliques

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94
Q

Manus standard views

A

Dpa
ML
Any oblique view to highlight specific digits and sesamoids

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95
Q

Special views of the manus

A

Stressed digit -> use porous tape or cotton wool to splay digits on ML view
Compression

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96
Q

Pelvis standard views

A

Laterolateral
Extended VD

Optional flexed frog leg VD

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97
Q

Pelvis special views

A

any oblique to highlight specific area

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98
Q

Hip dysplasia views

A

Extended VD
Penn hip

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99
Q

View of pelvis if one side positioned in front of the other

A

Right cranial left caudal oblique

(left would be in front (cranial) here)

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100
Q

Important factors in VD extended coxofemoral view (hips)

A

Entire pelvis in including proximal tibia

Must be symmetric = femurs parallel and patellae in middle of stifle (legs turned slightly in so patella superimposed over distal femur)

Animal in dorsal recumbency, collimation includes lasat 2 lumbar vertebrae and patellas

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101
Q

3 ligaments in sacroiliac joint

A

Dorsal sacroiliac ligament
Ventral sacroiliac ligament
Sacrotuberous ligament

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102
Q

Hip joint features

A

Joint capsule
Ligament of head of femur
Transverse acetabular ligament

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103
Q

VD flexed frog leg process and reason

A

Good for fractures and can see degree of subluxation in hip dysplasia

Dorsal recumbency
Pelvic limbs flexed
Collimation includes last 2 lumbar vertebrae, proximal femurs and tuber ischii

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104
Q

Penn hip method

A
  1. Obtains OA readings from standard hip extended view
  2. Obtains hip joint congruity readings from compressed view
  3. Obtains quantitative measurements of hip joint laxity from distraction view

Accurate in puppies as young as 16wks

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105
Q

What DI rating is unlikely to develop OA from hip dysplasia (penn hip)

A

DI <0.3 (femoral head comes out of joint by <30%) is unlikely to develop OA from hip dysplasia

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106
Q

Femur standard views

A

ML
CrCd

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107
Q

Stifle standard views

A

ML
CdCr or CrCd
Flexed ML

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108
Q

5 ligaments of the stifle joint

A
  1. Medial femoropatellar ligament
  2. Tendon of quad femoris
  3. Patellar ligament
  4. Medial collateral ligament
  5. Region of menisci (cranial and caudal cruciate ligament)
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109
Q

Skyline of patella view and its use

A

CrPrCrDiO

Used to better visualise patella and trochlear groove
Used in cases of medial or lateral luxating patella

Often in horses for sagittal fracture of patella

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110
Q

Standard views tarsus

A

ML
PlD
DPl

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111
Q

Special views tarsus

A

Flexed ML
Extended ML
Relevant obliques for pathology
Flexed DPl view (skyline)

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112
Q

For a horse with OCD what view of the tarsus is done?

A

Flexed ML

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113
Q

PlD view tarsus

A

Sternal recumbency
leg stretched out behind caudally
Easier to extend if dog has hip disease
Rotate stifle internally

114
Q

Pes (hind paw) views

A

ML
DP
Splayed

same as front toes

115
Q

5 causes of fractures

A

Trauma from external force
Trauma from internal force
Normal activity on diseased bone
Stress protection/stress riser -> weakened bone at end of plate
Defect in bone due to biopsy or surgery

116
Q

3 Reasons for missing a fracture

A

Incorrect exposure, positioning, not enough views
Non displaced fragments -> if hairline fracture suspected but not seen re-evaluate in 7-10d
Confusion with physees and other mimics

117
Q

What views should be taken to assess fractures

A

Several orthogonal views, obliques and stress views

118
Q

5 normal causes of radiolucent lines

A
  1. Nutrient foramen
  2. Normal physes
  3. Multipartite sesamoids/separate ossification centres
  4. Mach lines (bone overlying bone)
  5. Overlying fascial planes containing fat
119
Q

9 steps in describing fractures

A

BTPDUJASP

Bone involvement
Type of fracture
Physeal involvement
Displacement, angulation
Underlying bone pathology
Joint involvement
Age of fracture
Soft tissue injuries + infection
Presence of foreign material

120
Q

Fracture types - incomplete/complete

A

Open -> gas or foreign material in site, bone beyond skin margins, infection risk
Closed

Complete or incomplete -> does it involve both cortices?

Complete ->
simple - 1 fracture line, transverse, oblique, spiral OR
comminuted - 2 or more fracture lines, segmental (2 fracture lines isolating a segment) or butterfly fragments

Incomplete -> one cortex involved
Hairline -> thin fracture line, no disaplacement, full depth not involved
Greenstick -> cortex broken on convex side
Torus -> Cortex buckles on concave side

121
Q

Rest of the fracture types

A

Avulsion - bony insertion of ligament/tendon involved (slab or chip fracture)

Compression - often no line seen, bones impact into each other

Fatigue or stress fracture - from repeat trauma

Shearing fracture - abrasion type open fracture

Condylar fractures - involve condyle and metaphysis

Monteggia fracture - luxation of radial head with proximal ulnar fractures most likely from trauma, with types 1-5 based on degree of luxation of radial head

122
Q

Physeal growth plate fractures - how are they classed?

A

Occur only in immature animals
Classed according to degree of involvement of the epiphysis, physis and metaphysis

Salter Harris fracture types are correlated to chance growth deformity occurs when the fracture heals -> 1-5
1 is best prognosis 5 is worst

123
Q

Salter Harris fracture classes

A

1 -> through growth plate
2 -> through growth plate and metaphysis
3 -> through growth plate and epiphysis
4 -> through all 3 elements
5 -> crush injury of the growth plate

124
Q

3 other factors of fracture assessment

A

Joint involvement - articular fractures need stable fixation
Age of fracture - sharpness of bone edges
Presence of foreign material

125
Q

2 types of fracture healing, and factors to assess progress

A

Primary and secondary

ABCDS -> alignment, bone, cartilage/joint, decide, soft tissue
Post op rads taken at 2,4,6 weeks then monthly until healed

126
Q

Stages of secondary healing

A

5-10d
10-20d
>30d
>90d

127
Q

Characteristics of day 5-10 of fracture healing

A

Fragments lose sharp edge
Demineralization
Fracture widens

128
Q

Characteristics of day 10-20 of fracture healing

A

Endosteal and periosteal callus
Decrease size of fracture gap
Fragments lose opacity

129
Q

Characteristics of day 30 of fracture healing

A

Fracture line disappearing
Callus bridges
Remodeling

130
Q

Characteristics of day >90 of fracture healing

A

Callus remodeling
Cortex visible
Remodeling continuity of medullary cavity

131
Q

3 features of fracture healing

A

Bone continuity of cortex
Calcified and ossified complete bridging callus
No visible fracture line

Usually healed 6-8wks later if adequately stabilised

132
Q

Which type of healing is faster?

A

Secondary

133
Q

Primary vs secondary healing times in 2yr old dog

A

Primary -> 5-12 months
Secondary -> 2-3 months

134
Q

Secondary healing time in 4wk old puppy vs 1yr old dog

A

Pup -> 2-3 weeks
1yr old -> 8-12 weeks

135
Q

What is disuse osteopaenia?

A

Effects of non weight bearing especially if a cast is applied

Cortical thinning
Double cortical line
Reduced bone opacity
Coarse trabecular pattern

136
Q

What causes lysis adjacent to implants?

A

Loosening or infection

137
Q

6 factors affecting fracture healing

A

Blood supply
Type of fracture
Reduction of fracture
Stability
Age of animal
Concurrent disease or infection

138
Q

Radiographic signs of complications of fracture healing

A

No callus
Exuberant callus
Angulation or rotation of fragments
Lysis at fracture margin and separation of fragments
Zone of radiolucency around fixation devices within the bone
Failure of implants
Delayed union -> mostly due to instability

139
Q

What is malunion?

A

Bone healing but in abnormal position
Valgus
Varus

140
Q

Causes of infection in fracture healing

A

Open fracture
Contamination
Long surgical procedures
Excessive tissue damage
Foreign material

141
Q

What can cause a fracture induced sarcoma?

A

A metal plate that has irritated bone and caused a reaction due to chronic movement

142
Q

What is Metalosis ? What changes occur?

A

Chemolysis due to incompatible metals used for internal fixation which causes an osteolucent response around the implant resulting in loss of stability and implant failure.

Osteolytic changes appear similar in appearance to early osteomyelitis

143
Q

What is implant (hardware) failure?

A

Metal fatigue causing fractures of plates, screws or pins that causes instability and fraction non-union 

144
Q

What can happen to young animals with traumatic incidents to antebrachium?

A

The physis can close prematurely causing angular limb deformities where one bone stops growing and one continues and bends.

The distal ulna and radius are most commonly affected and it leads to joint incongruity

145
Q

Structural changes that occur after premature distal ulna growth plate closure:

A

Shortened ulna
Cranial and medial bowing of radius
Valgus Deformity
Humerus forced proximally
Widening on humeral-ulnar joint

146
Q

Structural changes during premature distal radius physis closure

A

Shortened radius
Widened humeral-radial joint space

147
Q

2 categories of a primary bone neoplasia

A

Malignant -> solitary, aggressive, often metaphyseal

Benign -> less common, slow growing

148
Q

Characteristics of secondary bone neoplasia

A

Metastatic
Haematogenous spread, multiple aggressive lesions,
Polyostotic distribution
Diaphyseal commonly (nutrient foramen located here)

149
Q

Is osteosarcoma malignant or benign? Where does it start?

A

Malignant -> also 85% of bone tumours

Starts in metaphysis of long bone

150
Q

Example of benign bone neoplasm

A

Osteoma - protruding cell mass with abnormally dense bone in the periosteum (skull and facial bones common)

151
Q

4 types of primary bone neoplasia and their occurrence as a %

A

Osteosarcoma 85% (highly malignant)
Chondrosarcoma 5-10% (malignant -> benign, diverse cartilage tumours)
Fibrosarcoma <5% (produce fibrous tumour rather than bone)
Haemangiosarcoma <5%

152
Q

Where are osteosarcoma common?

A

In juveniles in the distal femur

153
Q

Where does multiple myeloma occur?

A

Most common polyostotic malignant primary bone tumour

Occurs in bone marrow
Often originates in diaphysis

154
Q

Where does lymphoma of bone occur?

A

In reticular cells, lymphoblasts and lymphocytes of middle aged patients

155
Q

Where do malignant giant cell tumours occur?

A

Rare
Extremities of long bones

156
Q

3 things osteosarcoma could be associated with

What doesn’t it cross?

A

A fracture site months-years later
Internal fixation devices
Chronic osteomyelitis at the fracture site

The joint space

157
Q

3 locations osteosarcomas occur

A

Proximal 1/3 of humerus, distal 1/3 of radius and ulna

Distal 1/3 of femur and proximal 1/3 of tibia

Proximal 1/3 of femur rare and distal 1/3 of tibia rare

158
Q

Radiographic findings of osteosarcomas

A

Lots of lysis, monostotic, metaphyseal usually
Lysis is aggressive and involves cortex
Periosteal changes (sunburst, spiculated)
Soft tissue swelling or pathological fractures both may be present

Endosteal indentations resulting in cortical spike formations
Codmans triangle

159
Q

Features of benign bone neoplasia

A

No age, breed or site predilection
Causes lameness only when pathological fracture occurs

Geographic lysis, short transition

160
Q

3 types of benign bone neoplasia

A

Osteoma (face bump)

Osteochondroma - grows until phyis closes

Enchondroma - expanding medullary tumour

Bone cysts

161
Q

Osteoma description

A

dense cortical bone with smooth periosteal reaction

162
Q

Enchondroma description

A

Common benign intramedullary cartilaginous neoplasm
Trabeculae +/- radiolucent centre may be seen
Ddx - bone infarcts

Circles of new bone laid down, puts pressure on cortex

163
Q

Features of bone cysts

A

Expansile fluid filled radiolucent lesions in diaphysis/metaphysis of long bone
Well demarcated transition zone
Cortical thinning - path fractures

164
Q

Bone infarcts - where, what

A

Osteonecrosis in the metaphysis most commonly, can be diaphysis

Symmetrical or multiple infarcts

Shell like new bone formation and sclerosis with creeping, wavy margin
Discrete calcification and periostitis may also be seen

165
Q

What is an osteochondroma and what is the new bony growth in an osteochondroma called?

A

Osteocartilagenous exostosis

Multiple osteochondromatosis (multiple tumours)

Osteochondroma -> most common benign tumour of bone, occurs where cartilage being converted to bone. Grow until physis closes

Can be of viral cause in cats

166
Q

What is synovial osteochondromatosis?

A

Benign proliferative disease of the synovium with cartilage metaplasia, resulting in multiple intra-articular loose bodies

Ranges from synovial tissue to firm nodules of bone forming cartilage

Can occur idiopathic or secondary to osteoarthritis

Metaplasia -> conversion of one tissue type to another

167
Q

Common sites for metastatic bone neoplasia

A

Diaphysis or metaphyseal
Usually affects the diaphysis of long bone (but can be any bone)

Femur, humerus, vertebrae + ribs

168
Q

Generally Where do metastatic bone neoplasia occur? What is their appearance?

A

Downstream from blood vessel of primary area it started (often starts in lungs)

Aggressive and may be lytic and/or proliferative, often in older animals with no breed specifically

Eg multiple myeloma

169
Q

Example of a type of metastatic bone neoplasm

A

Multiple myeloma characteristically lytic with punched out appearance

Monoclonal gammopathy
Atypical plasma cell proliferation in bone marrow

Often vertebrae and ribs can be elsewhere

170
Q

Primary site for metastatic squamous cell carcinoma

A

Tonsillar

171
Q

Bone tumour and bone infection similarity

A

Both aggressive

172
Q

What would a solitary, aggressive metaphyseal lesion be?

A

Primary bone tumour eg osteosarcoma

173
Q

What are two things that happen with chronic infection in bone? (osteomyelitis)

A

Sequestrum -> increased mineral opacity
Involucrum -> irregular thickening of cortex of dead bone

174
Q

Two types of osteomyelitis

A

Fungal or bacterial

Both infection of bone

175
Q

What is bacterial osteomyelitis normally secondary to? and what symptoms are present?

A

an open wound - an extension from soft tissue injury, a puncture site, open fracture, surgical procedure

Osteomyelitis is inflammation of bone or marrow due to infection normally

Pain, fever, swelling, leukocytosis, fistulous tracts

176
Q

Differences between bacterial osteomyelitis and bone tumours - location, periosteal reaction

A

Osteomyelitis -> typically not metaphyseal, can be anwhere, not as aggressive as a bone tumour, can involve more than one bone, most have pallisading periosteal reaction (not spiculated like tumours) and may have small gas opacities

177
Q

What are the causes of bacterial osteomyelitis?

A

Occaisonally bacteraemia, haematogenous spread (usually in skeletally immature animals)

Bacterial endocarditis, neonatal umbilical infection

178
Q

What are the lesions like of haematogenous bacterial osteomyelitis?

A

Lytic, productive or mixed - depends on virulence of organism and immune system of animal

179
Q

Characteristics of fungal osteomyelitis - location, population it affects, origin

A

Mycotic
Geographic distributions
Young, large breed dogs (uncommon in cats)
Haematogenous in origin
Usually in metaphysis of long bones but can be diaphysis
Can cross joints - polyostotic

180
Q

3 common fungal agents causing osteomyelitis in australia

A
  1. Aspergillosis - immune compromised german shepherds
  2. Actinomcyes - from grass seed migration to vertebrae
  3. Cryptococcus

Can be confused with tumours - look for systemic illness and fever

181
Q

2 types of protozoan bone infections and signs

A

Leishmanisasis
Hepatozoonosis (rare)

fever, weight loss, muscle atrophy, ocular discharge, pain

182
Q

Radiographic lesions of protozoan infections

A

Limited to periosteum
Irregular profliferation or smooth
Polyostotic (multiple bones) aggressive lesions

183
Q

Acute radiographic signs of osteomyelitis

A

First leions seen at 7d when lysis/periosteal reaction occurs - proliferative and moderate aggression - can extend down shaft of diaphysis

Lysis of cortical and medullary bone

Diffuse soft tissue swelling

184
Q

Chronic radiographic signs of osteomyelitis

A

Sclerotic margin around lytic areas

Sequestrum formation

Periosteal proliferation may or may not be present

Soft tissue swelling

185
Q

6 differential diagnosis of osteomyelitis

A

Neoplasia
Bone cyst
Delayed fracture union as a result of instability
Hypertrophic osteodystrophy
Secondary hypertrophic osteodystrophy
Medullary bone infection

186
Q

2 types of subungal tumours

A

Squamous cell carcinomas - most common. Seen in large breed black dogs

Malignant melanomas

187
Q

A type of subungal infection

A

Pododermatitis

188
Q

Common factors between subungal infection and tumours

A

Both can occur in manus or pes at equal frequency
Both aggressive bone lesions with bone lysis

189
Q

Location of non-aggressive vs aggressive lesions

A

Non -> anywhere
Aggressive -> metaphysis (primary bone tumour) or diaphyseal (metastatic bone tumor)

190
Q

Bone destruction type of non-aggressive vs aggressive lesions

A

Non -> geographic

Aggressive -> permeative

191
Q

Cortical disruption of non-aggressive vs aggressive lesions

A

Non -> none

Aggressive -> broken or not seen, path fractures

192
Q

Zone of transition of non-aggressive vs aggressive lesions

A

Non -> sharp, distinct

Aggressive -> Indistinct, permeative, long zone of transition

193
Q

Periosteal reaction of non-aggressive vs aggressive lesions

A

Non -> smooth continuous

Aggressive -> Interrupted, variable, spiculated, amorphous

194
Q

What is hypertrophic osteopathy? What is it caused by?

A

Increased periosteal bone formation in long bones - starts distal and moves proximal

Mostly metatarsus and metacarpus

Caused by cardiopulmonary disease or neoplasia (pulmonary or intra-abdominal)

195
Q

Signs of hypertrophic osteopathy

A

Increased blood to extremities

Periosteal new bone formation (brush border to palisading) on digits and progressively extends proximally

Swollen extremities, lameness

Secondary to thoracic disease

196
Q

6 types of epiphyseal disorders

A

Osteochondrosis
Ununited anconeal process
Fragmented medial coronoid process
Hip dysplasia
Aseptic necrosis of the femoral head
Epiphyseal dysplasia

197
Q

What is osteochondrosis AKA

A

Developmental orthopaedic disease

198
Q

What is the cause of osteochondrosis?

A

Dysfunction of endochondral ossification (cartilage doesnt ossify properly and becomes thickened instead)

May necrose and cause cartilage flap -> Osteochondritis dessicans (OCD)

199
Q

Who and where does osteochondrosis normally affect?

A

Large breed dogs 4-10 monthsold
Bilateral
Shoulder (most common), elbow, stifle, tarsus, retained endochondral cartilage core (ulna), ununited anconeal process

focal area of endochondral ossification causing cartilgae thickening that can necrose, cause fissure, become a fragment seen on rads

200
Q

radiographic signs of osteochondrosis

A

Subchondral bone defect
Subchondral sclerosis (more bone laid down)
Calcified glap of cartilage free in joint (OCD, joint mouse)
Joint effusion and widened joint
Sometimes see gas in shoulder joint

201
Q

Population affected by elbow osteochondrosis and location in elbow

A

Males more than females
5-10 months old large breeds
Get a subchondral defect of the medial condyle and subchondral sclerosis

elbow (medial humeral condyle) is the second most common location after the shoulder

202
Q

Lesions seen in stifle osteochondrosis

A

Lateral condylar surface more commonly affected
Defect or flattening in articular surface
Subchondral swelling
Mineralised flap
Secondary osteoarthritis

203
Q

Lesions seen in tarsus osteochondrosis

A

Medial trochlear ridge (talus) most common
Widening of joint space
Flattened trochlear ridge
Subchondral sclerosis
Caudal mineralised flap
Secondary osteoarthritis
Tarso-crural effusion

204
Q

4 causes of elbow dysplasia

A

Genetics
overnutrition
joint incongruity
Specific joint disorders -> ununited anconeal process, fragmented medial coronoid process

205
Q

Ununited anconeal process -> breed, when it should be fused by, radiographic view

A

German shepherds - large breed dogs have separate anconeal ossification centre
5 months
Bilateral 30%
Males 2x more likely
Flexed ML view of the elbow

206
Q

Radiographic findings of ununited anconeal process

A

Radiolucent line separating anconeal process from olecranon after 20 weejs
Line irregular and of variable width
Ends on either side of physis sclerotic, secondary osteoarthritis

207
Q

Fragmented medial coronoid process -> breed, age, radiographic view

A

Medium - large breeds
Males
4-6 months of age
cranio15 degree lateral caudomedial oblique

208
Q

Fragmented medial coronoid process radiographic signs

A

ML -> sclerosis in interosseous space between proximal ulna and radius
Degenerative changes (osteophytic) on anconeal process and medial epicondyle
Rare to see actual fragment

209
Q

Hip dysplasia - who, bilateral or unilateral, underlying process

A

Large dogs but also small dogs and cats
Inherited, not present at birth - develops due to joint laxity leading to abnormal hip development and secondary osteoarthritis

Usually bilateral but can be unilateral

210
Q

Normal hip joints description

A

Deep cup shaped acetabulum
Smooth circular margin femoral head
>2/3 of head in dorsal rim
Parallel joint space
Narrow femoral neck

211
Q

Changes in HD in order of appearance

A
  1. Subluxation of 1 or both femoral heads
  2. Perichondral enthesophytes
  3. Remodelling of femoral head and neck
  4. Remodelling of the acetabulum
  5. Sclerosis of subchondral bone of femoral head and acetabulum
212
Q

Abnormal radiographic findings of HD

A

Shallow acetabulum
Flattening and subluxation of femoral head
Thickened femoral necks
Subchondral sclerolsis
Enthesophytes - bony spur arising from pulling of tendons or ligaments forming “morgans line”

213
Q

What is the norberg angle?

A

Measurement made from extended limb VD
Number represents laxity -> normal more than 105, abnormal less than 90, borderline in between

214
Q

How does the feline coxofemoral joint differ from that of a dog?

A

It has shallower acetabulum reflected in the norberg angle being 92.4

215
Q

Who does aseptic necrosis of the femoral head affect?

Legg-Calves Perthes disease

A

Small young dogs -> terriers, poodles, chihuahua
3-10 months old

Not in cats -> but analagous condition called capital physeal dysplasia in cats

216
Q

What is aseptic necrosis of the femoral head

A

Femoral head loses blood supply and becomes necrotic
can subluxate and then get degenerative changes

217
Q

Initial and then progressive radiographic signs of aseptic necrosis of the femoral head

A

Unilateral or bilateral coxofemoral oesteoarthritis

Intially -> lysis of femoral head, mottled pattern of patchy lysis due to bone necrosis

Progresses to -> femoral head collapse, changes in opacity and remodelling of femoral neck

Finally -> joint remodels to a shallow acetabulum, wide joint space, DJD, muscle atrophy

218
Q

What is epiphyseal dysplasia?

A

Incomplete ossification of humeral condyles leading to humeral condylar fractures with normal exercise

The other elbow can have fissure lines and coronoid process fragmentation too so check this

219
Q

Who does epiphyseal dysplasia affect?

A

Hereditary in spaniels, pure and cross bre
Mostly males

220
Q

When should the humeral condyles be ossified by?

A

84d

221
Q

6 physeal disorders

A
  1. Physeal (growth plate) trauma
  2. Rickets
  3. Feline femoral capital physeal dysplasia
  4. Endochondral osteodystrophy
  5. Retained cartilagenous core
  6. Osteochondroma
222
Q

What does physeal trauma cause?

A

Closure of a growth plate prematurely causing bowing of other bone that still grows

eg radius or ulna

223
Q

What is rickets?

A

Excessive growth of physeal cartilage, a result of endochondral ossification failure on the metaphyseal side of the physis

Occurs in animals not getting enough nutrition and physis keeps widening

224
Q

What is feline femoral capital physeal dysplasia and who does it affect?

A

Young male cats - heavy and desexed <6mo

Spontaneous capital physeal separation - usually unilateral, dysplasia of chondrocytes in growth plate

225
Q

Radiographic signs of feline femoral capital physeal dysplasia

A

Capital separation, osteolysis+ sclerosis of femoral neck

Apple core appearance of femoral neck

226
Q

1 diaphyseal disorder

A

Panosteitis

227
Q

Panosteitis - who does it affect, what is it

A

Unknown cause - could be viral, not inflammatory

Affects large breed dogs - male german shepherds between 5-12 months of age, unexplained painful lameness shifting from one leg to the other

Present in one or more tubular bones of appendicular skeleton

Thumb print like appearance

228
Q

Radiographic signs of panosteitis

A

Increased intra-medullary radio-opacity
Loss of trabecular pattern - hazy opacity
Diffuse granular appearance of increased opacity (thumbprints)

Endosteal bone thickening
Smooth periosteal new bone
Near nutrient foramen

Eventually normal remodelling

229
Q

2 metaphyseal disorders

A
  1. Hypertrophic osteodystrophy
  2. Congenital bone cysts
230
Q

Hypertrophic osteodystrophy - who it affects, what it is

A

Rapidly growing large dogs 2-7 months old
Cause unknown

Metaphyses of long bones swollen and painful, inflammatory response that is self-limiting with fever and diarrhoea sometimes seen

translucent zone appears in metaphysis parallel and adjacent to the physis then new periosteal bone deposited all the way around metaphysis (flaring and sclerosis of the metaphysis)

Soft tissue swelling and premature closure of physis may occur

231
Q

Which bones does hypertrophic osteodystrophy affect?

A

Distal radius and ulna
May also affect axial skeleton

232
Q

What is retained endochondral cartilage core?

A

A failure of endochondral ossification that most commonly affects the distal ulnar physis.
Common in large breeds

Can retard growth of ulna resulting in radius curvus and valgus deformity

Physis is normal

Bilaterally symmetrical

233
Q

What are congenital monostotic bone cysts?

A

Slow expansile lesions of metaphysis with smooth margins, firm non painful swelling and pathological fractures

Benign and slow growing but weaken cortex

Large and giant breeds

234
Q

What is an osteochondroma? Where is it normally?

A

Abbherant growth centre causing focal outgrowth of bone that grows until physes close

Often on distal ulna impinging into normal radius

Benign

Causes feline leukaemia virus in cats
Inherited in dogs

235
Q

Where are osteochondroma on vertebrae and ribs?

A

Peri-metaphyseal periosteal location

236
Q

3 congenital generalised bone disorders

A

Dwarfism - many disorders in here
Osteopetrosis
Scottish fold osteodystrophy

237
Q

2 acquired nutritional bone disorders

A

Nutritional hyperparathyroidism
Hypervitaminosis A

238
Q

1 congenital or acquired bone disorder

A

Renal hyperparathyroidism

239
Q

2 types of dwarfism syndromes

A

Disproportionate or proportionate

240
Q

Disproportionate dwarfism characteristics

A

Part of skeleton reduced
Skull and spine unaffected, limbs shortened
Dashies
Short legged, chondrodystrophoid changes in long bones

241
Q

Proportionate dwarfism syndromes and examples in dogs and cats

A

Entire skeleton reduced in size - toy poodles

Dogs - hypopituitary/hypothyroid german shepherds

Cats - mucopolysaccharidosis -> siamese eg, it is a genetic lysosomal storage disease with abnormal facial appearance, cloudy corneas

242
Q

What is chondrodysplasia?

A

Dwarfism syndrone inherited - normal in dashies

bone development and physeal closure times are same as in non-chondrodystrophic animal

Abnormal in labs, alaskan malamute

Appendicular bones are short, tubular and bowed with widened metaphysis

Vertebrae are sqaure

243
Q

What is congenital epiphyseal dysplasia?

A

A dwarfism syndrome

Hypothyroidism and low growth hormone levels

Patchy ossification in epiphysis - stippled

Beagles

244
Q

What is osteochondral dysplasia?

A

Disorders of development of bones
Metatarsals short and misshapen
Severe osteoarthritis

Scottish folds

245
Q

What is the cause of osteopetrosis? What do we see?

A

Congenital rare hypervitaminosis D with excess bone formation and increased opacity in medulla
Thickened cortices
Bones are brittle and fracture easily

246
Q

What is secondary nutritional hyperparathyroidism?

A

Failure of osteoid to calcify due to Ca:P imbalance or vitamin D deficiency

Osteopaenia due to osteomalacia -> decreased radio-opacity of bone, cortical thinning, prominant trabeculae, soft bones, metaphyseal bone remains with good well mineralised opacity

247
Q

What syndrome does renal secondary hyperparathyroidism cause in dogs?

A

Rubber jaw

248
Q

Who does hypervitaminosis A affect?

A

Cats with liver rich diet

Causes periarticular bone formation and ankylosis (fusion of bones) of affected joints -> kangaroo cats

249
Q

Causes of monoarticular joint problems

A

Trauma, neoplasia, septic

250
Q

Causes of multi-articular lameness

A

Polyarthritis, geriatric osteoarthritis

251
Q

9 radiographic signs of joint disease

A
  1. Increased synovial mass
  2. Altered thickness of the joint space
  3. decreased or increased subchondral bone opacity
  4. Subchondral cyst formation
  5. Altered perichondral bone opacity, enthesophytes or osteophytes
  6. Mineralisation of joint soft tissues
  7. Intraarticular calcified bodies
  8. Joint luxation/subluxation
  9. Joint malformation
252
Q

Causes of decreased subchondral bone

A

Inflammatory exudates or infectious arthritis
Developmental -> disease where cartilage does not ossify

253
Q

Causes of widened joint space

A

Early in disease -> synovial effusion
Ligament damage also

254
Q

Cause of narrowing joint space

A

Cartilage erosion

255
Q

Where is perichondral bone?

A

Where synovium merges with articular cartilage

256
Q

Causes of decreased subhondral bone opacity

A

Inflammatory exudates

Infectious arthritis can also extend into subchondral bone

257
Q

Causes of increased subchondral bone opacity

A

Degenerative joint disease (benign joint disease)

258
Q

What is an osteophyte?

A

New bone formation at periarticular margins

will be right near joint - otherwise it is an enthesophyte

259
Q

Causes of increased perichondral bone opacity

A

Ossification of fibrocartilage on chondrosynovial junction produces enthesophytes (new bone formation from traction at osseous attachments) that can incorporate into the joint capsule

this happens in osteoarthritis

260
Q

Causes of decreased perichondral bone opacity (at the chondrosynovial junction)

A

Inflammation of the synovial membrane causes the adjacent bone to appear irregular

Immune mediated diseases and villonodular synovitis

261
Q

3 causes of large accumulations of articular or periarticular calcific material

A

osteochondroma in joints of dogs and cats

pseudo-gout (calcium pyrophoshate deposition disease)

intra-meniscal calcificiation and ossification in cats stifles

262
Q

What are joint mice? what are the 3 catagories?

A

Intra-articular calcified bodies
not all are free in the joint

  1. Avulsed fragment of articular or periarticular bone
  2. Osteochondral components of a disintegrating joint surface
  3. Small synovial osteochondromas
263
Q

Who suffers with medial luxation of the patella?

A

Toy dogs and devon rex cats

264
Q

What is the most common joint problem? What are its causes?

A

Osteoarthritis - DJD increases with age
Usually secondary, but primary in older patients

Old age
Secondary to developmental disorder - hip dysplasia, elbow dys.
Aquired - trauma, post joint infection

265
Q

Progressive radiographic signs of DJD

A

Synovial effusion compressing the intrapatellar fat pad and displacing caudal fascial planes caudally

Periarticular enthesopathy and osteophytes

266
Q

Progressive changes of DJD

A

Narrowing of joint space
Sclerosis of subchondral bone
Osteophytes
Enthesophytes
Complete ankylosis (final stage)

267
Q

Osteoarthritis in cats features

A

Tend to produce exuberant periarticular new bone

Intra-articular mineralisation is more common

268
Q

Two types of polyarthritis

A

Erosive -> immune mediated - IgG auto-antibodies. Swelling seen, narrow joint spaces, joint effusion, subluxation, destruction of articular bone

Non-erosive -> dogs, immune mediated. Radiographs only show intracapsular sweling and in severe cases OA

269
Q

Most commonly affected joints of erosive arthritis (rheumatoid)

A

Carpus
Tarsus
Phalanges

270
Q

Cause of non-erosive polyarthritis

A

Systemic lupus erythematosis in dogs and cats - anaemia, nephropathy, pericarditis, skin disease

271
Q

4 types of immune mediated feline polyarthropathy

A
  1. Periosteal proliferative polyarthritis - most common form, young male cats extremities and systemic illness
  2. Rheumatoid arthritis (erosive form in older cats)
  3. SLE - antinuclear antibodies in blood, no distinct rad signs
  4. Idiopathic polyarthritis -> myeloproliferative disease association (no distinct rad signs). Needs bone marrow biopsy
272
Q

Initial signs of septic arthritis

A

Non-specific to any effusive non-erosive joint disease

Synovial effusion, increased synovial mass and widened joint space

273
Q

What can septic arthritis spread from?

A

An associated osteomyelitis

274
Q

Progressive radiographic signs of septic arthritis

A

Diminished radiolucent joint space (destruction of articular cartilage)
Subchondral bone destruction (more severe than OA)
Advanced -> weight bearing surfaces collapse

275
Q

Types of septic arthritis

A

Physeal
Epiphyseal
Synovial
Tarsal bones
Carpal bones

276
Q

2 most common neoplasias of joints

A

Synovioma
Synovial cell carcinoma

277
Q

Neoplasia of joints vs primary bone tumours

A

Neoplasia of joints affects the bone either side of the joint and are primarily lytic

Bone tumours dont

278
Q

Most commonly affected joints for synovial cell carcinoma

A

Uncommon in dog and rare in cat

Stifle and elbow

279
Q

4 radiographic signs of severe sprains

A
  1. Periarticular soft tissue swelling
  2. Avulsion fractures at points of attachment of ligaments, tendons and capsules to bone
  3. Signs of joint instability or subluxation
  4. Spatial derangement of osseous components of the joint
280
Q

Signs of cruciate ligament injury

A

Enthesopathy at the insertion of the cranial cruciate ligament on the cranial aspect of the tibial plateau
Intracapsular soft tissue swelling
Thickening of medial joint capsule

281
Q

Bicipital tendinopathy signs

A

Large breeds
Intermittent weight bearing front limb lameness
Focal mineralised bodies (osteophytes) near greater tubercle
Remodeling of supraglenoid tubercle

Fourth Year (8 decks)

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