Diagnostic Imaging Flashcards
osteochondroma
MC benign bone tumor of the appendicular skeleton
either pedunculated (coat hanger exostosis/cauliflower) or sessile
20% undergo malingnancy
multiple osteochrondroma
hereditary multiple exostosis
unicameral bone cyst
Simple bone cyst
diaphyseal/metaphyseal location, centrally located, <20yo
aneuysmal bone cyst
diaphyseal/metaphyseal location, eccentrically located, <20yo
giant cell tumor
epiphyseal/metaphyseal location, 20-40yo, 20% of the time quasi-malignant
chondroblastoma
epipyseal/metaphyseal location, <20yo
osteoid osteoma
nightpain releived by aspirin
radiolucent central nidus with severe reactive sclerosis
brodie’s abscess
AKA chronic osteomyelitis
night pain relieved by aspirin; appears like an osteoid osteoma
enchondroma
MC BBT of hand. may have a stippled appearance
enchroncroma with soft tissue calcification
Maffucci’s syndrome
multiple enchrondromas
ollier’s disease
10-50% malignant degeneration
hemangioma
MC BBT of spine
will appear with vertical striations (corduroy cloth appearane)
enostoma
bone island
round or oblong radiopaque lesion
osteopoiklilosis
multiple bone islands
osteoblastoma
MC BBT to affect neural arch
osteoma
MC BBT of skull
MC found in frontal sinus and best seen on the Caldwell projection
fibrous dysplasia
monostotic form (70%) associated “rind sign”
pollystotic form (30%)
physiologic resorption of normal bone replaced by fibrous tissue
causes saber shin tibia, shepard’s rook, ground glass appearance, cafe au lait spots, coast of Maine appearance
neurofibromatosis
familial history
patient may present with scoliosis, cervical kyphosis, vertebral body scalloping with IVF enlargement
cafe au lait spot
coast of Maine appearance
multiple myeloma
> 50, cachexia, weight loss, anemia, most common primary malignancy of bone, malignant proliferation of plasma cells infiltrating bone marrow
normocytic normochromic
multiple diark densities that are similar in size (punched out lesions), can cause pathological collapse
rain drop skull
labs associated wtiht mulitple myeloma
M spike on immunoelectrophoresis reversal of A/G ratio bence-Jones proteinuria elevated ESR cold bone scan
metastatic disease
lytic and blastic
most common malignnant tumor of bone
lytic metastasis
> 40yo recent unexplained weight loss, skeletal pain worse at night
trabeculae reabsorbed turn the bone karder in color. moth eaten or permeative pattern of destrucion
“eats” pedicle of bone
swiss cheese appearance in skull
labs associated with kytic metastasis
alkaline phosphatase
hot bone scan
hodgkin’s disease
most common form of metastasis in ages 20-40
ivory white vertebrae with anterior body scalloping
unilateral hilar lymphadenopathy in causasian males seen in PA chest view
need biopsy to confirm (reed sternberg cells)
blastic metastasis
> 40yo ivory white vertebrae; no cortical thickening or bone enlargement
labs: increased aklaline phosphatase
hot bone scan
paget’s
males >50yo
stages: lytic/destructive, combined, sclerotic, malignant(osteosarcoma)
causes cortical thickening, picture frame vertebrae, increased bone density, coarsened trabeculae, bone expansion, bowing deformities, pelvic bim thickening, osteoporosis circumscripta
labs for paget’s
increased alkaline phosphatase and urinary hydroxyproline
hot bone scan
osteosarcoma
MC malignancy found in children 10-30yo
causes a periosteal reaction that is spiculated/radiating/sunburst in appearance
labs for osteosarcoma
increased alkalkine phosphatase
bone scan
chondrosarcoma and fibrosarcoma
> 400 creates a spiculated/radiating/sunburst periosteal reaction of bone
ewing’s sarcoma
10-25yo MC found in diaphysis of long bones
permeative lesion taht causes a milti-paralleled onion skin (laminated) type of periosteal reaction
bone expansion
codman’s triangle, saucerization
chordoma
> 40yo aberrant notochordal cell tumor. MC found in sacrum, second most commonlocation is in the skull
scoliosis
females 13-19, named for side of major convexity
types of scoliosis
rotatory (spinouses deviate to concavity
simple scoliosis-spinouses deviate to convexity
lines of mensuration for scoliosis
cobb’s and risser ferguson’s
scoliosis measurements for 25 years and younger
under 20 degrees: adjust and monitor
21-40 degrees: send to orthopedist for bracing (Milwaukee)
over 40 degrees: surgical consultation
over 50 degrees: cardio-pulmonary compromise and DJD
how to monitor scoliosis
risser’s sign
wrist films
rheumatoid arthritis
symmetrical distribution, bilateral uniform loss of joint space, rat biet erosions, pannus formation, localized periarticular osteoporosis, DIP spared, atlanto-axial instability
signs/labs with RA
haygarth’s
swan neck, boutonniere deformity
ulnar or fibular deviation (Lanois deformity)
baker’s cyst
labs: +RA latex, +FANA, +ESR, +CRP, normocytic normochromic anemia
AS (Marie Strumpell)
males 15-35yo, low back pain with morning stiffness. starts in SIjoints
associated with iritis
orthopedics for AS
chest expansion, forester’s bowstring, lewin supine
radiographic signs for AS
bilateral SI joint fusion shiny corner sign bilaterl marginal syndesmophytes squaring of vertebral bodies bamboo spine dager sign trolley track sign poker spine carrot stick fracutre
labs for AS
+HLA B27
+ESR
enteropathic arthropathy
identical to AS in pelvis with GIdysfunction
psoriatic arthritis
males 20-50
silver scaly lesions on extensors, pitted mails, cocktail sausage digits
increase in joint space, mouse ear deformity, pencil in cup deformity, ray sign, atlanto-axial instability, non-marginal syndesmophytes in the spine
+HLA B27
reactive arthritis
males 20-30
urethritis, conjunctivitis, arthritis, caused by chlamydia
calcaneal spur, fluffy periostitis, non-maringal syndesmophytes in apine
+HLA B27
SLE
females, sunlight precipitates a skin rash, ural ulcers, discoid lesion, alopecia, raynaud’s phenomenon
can cause ulnar deviation of phalanges with no joint destruction
positive rebound effect
labs for SLE
+LE prep, +FANA, +FA latex, +ESR, leukopenia, thrombocytopenia
co manage with rheumatologist
scerloderma
females 30-50yo
associated with erosions of teh distal tufts of the phlaanges (acro-osteolysis)
associated with CRESTsyndrome
labs associated with Scleroderma
+FANA, +RA latex (30%)
osteitis condensans ilii
multiparous females, 204-yo
bilateral/symmetric triangular sclerotic area on the lower half of the ilium. joint space is normal
self resolving, no labs
case management:trochanteric belt for stability
DJD
non-inflammatory, MC involves weight bearing joints
usually stiffens with rest and improves with activity
complications: spinal stensosis, IVF encroachment, MC site in spine is C5/6
DJD in spine
IVD narrowing, osteophytes, edplate sclerosis
DJD in hand
heberden’s nodes
decresed joint space with sclerosis
asymmetrical distribution, non-uniform loss of space
DJD in hip
decreased superolateral joint space with sclerosis
knee DJD
decreased medial joint space with lateral space preserved
DISH
males>40 with neck stiffness or pain onswallowing
associated with diabetes mellitus
can cause ossification of PLL, and ALL
radiographic findings of DISH
flowing hyperostosis, candle wax drippings, 4 contiguous segments involved, disc space preserved
neurogenic arthropathy (charcot’s joint)
secondary to imparied sensory function in joints
seen in diabetes tabes dorsalis, syphilis, syringomelia
6Ds common in weight bearing joints
distention, density of subchondral sclerosis, debris within joint, dislocation, disorganization, destuction of bone
synoviochondrometaplasia
MC joint affected is knee
results i multiple loose bodies within the joint that ar round or ovoid in shape
