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Diagnostic Imaging COPY 515 > DiIm2 Exam 3 > Flashcards

DiIm2 Exam 3 Flashcards

1
Q

What is the most common bone malignancy we’ll see?

A

Metastatic Disease (70%)

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2
Q

What is the most common primary malignant tumor in adults?

A

Multiple Myeloma

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3
Q

What is the most common primary malignant tumor in kids?

A

Osteosarcoma

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4
Q

What is the most common benign osseous tumor?

A

Osteochondroma

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5
Q

What is the most common benign spinal tumor?

A

Hemangioma

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6
Q

What 4 areas of the skeleton do tumors like to be?

A
  1. Red bone marrow (hemopoietic tissue)
  2. Notochord remnants
  3. Areas of rapid bone growth
  4. Areas w/ many interosseous nerves
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7
Q

Of the 3 patterns of bone destruction, which is the least aggressive?

A

Geographic; usually slow-growing, solitary lesion with well defined margins

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8
Q

How would you describe a moth-eaten pattern of bone destruction?

A

Numerous, small holes with poorly defined margins; moderately aggressive

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9
Q

What is the most aggressive pattern of bone destruction?

A

Permeative; aggressive, rapidly-growing lesion creating numerous small holes w/ poorly defined borders.

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10
Q

What is buttressing?

A

Additional layers of new bone added to outside of bone; associated w/ slow growing lesions

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11
Q

What tumor do we associate onion-skinning with?

A

Ewing’s Sarcoma

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12
Q

With what tumor do we associate a ‘sunburst’ or spiculated periosteum?

A

Osteosarcoma

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13
Q

What is a codman’s triangle?

A

Triangular elevation of periosteum; most aggressive of periosteal rxns.

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14
Q

What is the only type of tumor matrix we can see on x-ray?

A

Osseous; everything else will look like a hole

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15
Q

If a cartilaginous matrix tumor somewhat calcified, what would it look like on x-ray?

A

C-shapes, popcorn balls (flocculent), small dots

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16
Q

Are bony expansion & a periosteal reaction seen w/ primary or secondary neoplasms?

A

Primary

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17
Q

What is the difference in the size of the lesion when comparing primary neoplasms w/ secondary neoplasms?

A

Primary-Large (bigger than 3cm)

Secondary-Small (less than 1cm)

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18
Q

What is still the number one imaging modality for tumors?

A

Plain film

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19
Q

Lytic mets in a female likely come from the ___ whereas lytic lesions in males usually come from the ___.

A

Lytic Female–>breast

Lytic Male–>lung

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20
Q

Blastic mets in a female likely come from the ___ whereas blastic lesions in males usually come from the ___.

A

Blastic Female–>breast

Blastic Male–>prostate

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21
Q

Expansile, soap-bubbly mets likely come from which 2 primary sources?

A

Either kidney or thyroid

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22
Q

What is the most common means of metastasis?

A

Hematogenous (via the blood) thru the BATSONS VENOUS PLEXUS

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23
Q

What is the Batson’s Venous Plexus?

A

valveless system draining organs; runs along the spine

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24
Q

Serum calcium would be elevated in ____ mets.

A

Lytic; because the bones being destroyed so the calcium ends up in the blood

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25
Q

What age do we typically see metastatic disease?

A

40+ y.o.

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26
Q

What are some red flags for metastatic disease?

A

Unexplained weight loss, sickly-looking, anemic, fever

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27
Q

What are the top 3 sites for mets?

A

Spine, Ribs, Sternum

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28
Q

If a patient has acro-metastasis, where is the primary site most likely?

A

Lung cancer

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29
Q

What is generally a good thing to see when further examining pedicle destruction?

A

Contralateral compensation; indicates just a congenital pedicle absence. If no compensation, pedicle destruction likely caused by mets

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30
Q

What is the most common cause of pathologic collapse of the vertebra? 2nd? 3rd?

A

1st MC-Traumatic fx (osteoporosis)
2nd MC-Metastatic carcinoma
3rd MC-Multiple myeloma

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31
Q

If you saw a pathologic collapse of the vertebra in a kid, what are you thinking?

A

Eosinophilic granuloma

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32
Q

What are the top 3 causes of a solitary ivory vertebra?

A

Pagets Dz,
Hodgkins lymphoma,
Osteoblastic metastasis

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33
Q

__-___% of bone must be gone before it’s noticeable on x-ray?

A

30-50%

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34
Q

What is osteopoikilosis?

A

Multiple, well-defined bone islands that occur around major joints; no pain or abnormal biomechanics=congenital variant

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35
Q

What is the age and sex of preference for multiple myeloma?

A

50-70y.o

Males (2:1)

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36
Q

Word association: M-spike?

A

Multiple myeloma (also know M-spike is seen on protein electrophoresis)

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37
Q

Are multiple myeloma lesions usually painful?

A

Yep, usually first initial symptom

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38
Q

Where do multiple myelomas love to be?

A

Axial skeleton (Vertebra, skull, pelvis)
Ribs
Clavicle & Scap
Femur & Humerus

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39
Q

Word association: Raindrop skull?

A

Multiple myeloma

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40
Q

What is a solitary plasmacytoma?

A

Localized form of MM (before it’s spread); rare to catch at that stage

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41
Q

How does solitary plasmacytoma present?

A

Expansile lesion usually in the vertebra but SPARES the posterior elements; 70% will progress into MM

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42
Q

What is the 2nd most common primary malignant bone tumor overall?

A

Osteosarcoma

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43
Q

What is the bimodal distribution of osteosarcoma?

A

Appears commonly at two different ages; 10-25y.o. then again after 60y.o.

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44
Q

Are osteosarcomas more likely to affect males or females?

A

Males (3:2)

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45
Q

What are the clinical features of osteosarcoma?

A

Insidious pain, swelling with pain becoming more severe and persistent.

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46
Q

Where are osteosarcomas going to present: epiphysis, metaphysis, diaphysis?

A

Metaphysis

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47
Q

In young osteosarcoma cases, the tumor likes ____ bones, but in older osteosarcoma cases, the tumor likes ___ bones.

A

Young (Under 30y.o)= Cylindrical bones

Old (over 50y.o.)=flat bones

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48
Q

Where is it normal to see phleboliths?

A

Near the pelvic rim; if they are more central something (in this case tumor) is pushing them into the center

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49
Q

What is a parosteal osteosarcoma?

A

Lesion not in central canal but the edge of the bone; least invasive & is easily resectable

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50
Q

T/F: Osteosarcoma has a good 5 year survival rate with amputation and chemo.

A

True: 75% with both therapies; amputation alone only 20% have 5 yr survival

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51
Q

What is the age and sex preference for chondrosarcomas?

A

Over 50 y.o.

Males (2:1)

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52
Q

T/F: Chondrosarcomas have a late onset of pain, but grow rapidly and are aggressive.

A

False: late onset of pain, slow growing, less aggressive

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53
Q

Where do chondrosarcomas love to be?

A

Pelvis, Prox humerus, Femoral neck, Ribs, Sternum

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54
Q

T/F: If one has pain with a chondrosarcoma, it has a higher malignant potential than a non-painful chondrosarcoma.

A

True

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55
Q

What is the survival rate of chondrosarcomas with early surgery?

A

90%

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56
Q

What is the second most common primary bone tumor of kids?

A

Ewing’s Sarcoma

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57
Q

What is the age and sex preference for Ewings?

A

10-25 y.o. (same as osteosarcoma)

Males (1.3: 1)

58
Q

Do Ewings present w/ pain?

A

Yes, severe localized pain, with palpable soft tissue mass

59
Q

How do you differentiate osteosarcoma from Ewings?

A

Ewings–> likes midshaft (diaphysis)

Osteosarcoma–>likes growth plates (metaphysis)

60
Q

What is the age and sex preference for giant cell tumors?

A

20-40 y.o.

No sex preference 1:1

61
Q

T/F: Females are more likely to have a malignant giant cell tumor than males.

A

True

62
Q

What areas do the giant cell tumors love to be in?

A

Knee, wrist (distal radius), sacrum near SI, prox humerus

63
Q

What is the most common benign tumor of the sacrum?

A

Giant cell tumor

64
Q

What are some special rad features of giant cell tumors?

A

One big lesion (may be expansile), eccentric (off to side of medullary canal), extends to the subarticular region

65
Q

What is ‘bone packing’?

A

Take bone chips from the ilium and fill in an area of tumor. Healing process takes over and heals like a fracture would.

66
Q

T/F: Malignant giant cell tumors have a good 5 year survival rate.

A

False 10%…the good news is only 20% are malignant; the majority are benign giant cell tumors

67
Q

What is the age of occurrence for solitary osteochondromas?

A

Younger than 20y.o. (also no sex preference)

68
Q

Are osteochondromas usually symptomatic?

A

No, painless hard mass that only hurts if it gets fractured

69
Q

T/F: Osteochondromas are always benign.

A

False: If they become painful or start growing again later in life–>malignant transformation

70
Q

A ___ osteochondroma has a stalk-like base whereas a ___ osteochondroma has a broad base.

A

Pedunculated-stalk

Sessile-broad

71
Q

Where as sessile osteochondromas most common in the body?

A

Humerus & Scapula

72
Q

Where are pedunculated osteochondromas most common?

A

Knee, hip, ankle

73
Q

Word association: coat hanger exostosis?

A

Solitary osteochondroma (pedunculated variety)

74
Q

Where should you never see a osteochondroma?

A

Skull bones because they don’t utilize endochondral ossification

75
Q

Supracondylar processes grow ____the joint whereas osteochondromas grow ____ the joint.

A

Supracondylar process-towards the joint

osteochondromas-away from the joint

76
Q

What is the autosomal dominant condition characterized by multiple osteochondromas?

A

Hereditary Multiple Exostosis (HME)

aka Diaphyseal Achalasia

77
Q

When is hereditary multiple exostosis most common and is there a sex preference?

A

2-10 y.o.

Males (2:1)

78
Q

T/F: Having a foreshortened extremity is a complication of HME.

A

True

79
Q

T/F: The more exostoses you have, the more likely to have malignant transformation.

A

True

80
Q

What is a madelung deformity?

A

Associated w/ HME; curving of radius over a shortened ulna

81
Q

Where are exostoses most common in HME?

A

Metaphysis of long bones

82
Q

What are the 2 tumor-like conditions we discussed?

A

Simple bone cyst

Aneurysmal bone cyst

83
Q

What are the contents of a simple bone cyst?

A

Fluid (serous)

84
Q

What is the age and sex preference for simple bone cysts?

A

3-14y.o

Males (2:1)

85
Q

How can you tell a giant cell tumor from a simple bone cyst?

A

GCT: usually achy pain, eccentric, 20-40y.o
SBC: asymptomatic unless fx, central lesion, 3-14y.o.

86
Q

Where do simple bone cysts like to be?

A

Central part of prox humerus, prox femur, calcaneal neck

87
Q

Word association: truncated cone appearance?

A

Simple bone cyst

88
Q

If you see a fallen fragment sign, what lesion are we looking at?

A

Simple bone cyst

89
Q

What is the most effective treatment for a simple bone cyst?

A

drain fluid, & inject steroids

90
Q

What is the non-neoplastic, expansile lesion filled w/ blood?

A

Aneurysmal bone cyst

91
Q

What is the age & sex preference for aneurysmal bone cysts?

A

10-30y.o.

FEMALES**

92
Q

T/F: Aneurysmal bone cysts usually occur following a trauma.

A

True

93
Q

T/F: Like solitary plasmacytomas, aneurysmal bone cyst usually spare the posterior elements of vertebrae.

A

False: Love to be in the spine in that neural arch

94
Q

What are the two types of aneurysmal bone cysts?

A

Fusiform or rounded

95
Q

How could you tell a giant cell tumor from a ABC?

A

ABC-10-30yo, NOT subarticular

GCT: 20-40yo, subarticular

96
Q

What are the clinical features of osteoblastomas?

A

10-20y.o. (MC males 2:1) with dull pain that came on gradually, may have swelling and tenderness

97
Q

Where do osteoblastomas love to be?

A

Spine (in the posterior arch structures), Long bones, bones of hands and feet

98
Q

Excluding bone marrow biopsy, what is the best confirmatory test for multiple myeloma?

A

Protein electrophoresis–looking for the M spike

99
Q

Word association: Bence Jones proteinuria?

A

Multiple myeloma

100
Q

Which benign lesion is characterized by extreme pain that gets worse at night but aspirin relieves the pain?

A

Osteoid osteoma

101
Q

What is the age and sex preference for osteoid osteoma?

A

10-25y.o. & male preference

102
Q

What bones does the osteoid osteoma love to be in?

A

Prox femur, prox tibia, prox humerus, spine (posterior elements but non expansile)

103
Q

Word association: Nidus with reactive sclerotic rim?

A

Osteoid osteoma

104
Q

Which imaging is used for diagnosing osteoid osteoma?

A

CT

105
Q

What is the ‘double density sign’?

A

Osteoid osteoma on bone scan has really high activity over nidus, and slightly less activity over reactive thickening. (black with dark grey rim)

106
Q

T/F: Osteoid osteomas turn malignant in 10% of diagnosed cases.

A

False. No malignant potential

107
Q

Which benign tumor only comes about in membranous bones?

A

Osteomas

108
Q

At what age do most osteomas occur?

A

Adulthood

109
Q

Where do we most often see osteomas?

A

Paranasal sinuses (frontal & ethmoid)

110
Q

What is the age and sex preference for enchondromas?

A

10-30y.o. & no sex preference (1:1)

111
Q

T/F: The closer the enchondroma is to the axial skeleton, the more malignant potential it has.

A

True

112
Q

What is Ollier’s Disease?

A

Nonhereditary; multiple enchondromas affecting hands and feet, usually present in childhood (AKA Enchondromatosis)

113
Q

What is the term for having multiple soft tissue hemangiomas in addition to having Ollier’s Disease?

A

Maffucci Syndrome

114
Q

How do the soft tissue hemangiomas of Maffucci Syndrome appear on x-ray?

A

Small calcific densities around the soft tissue of the hands

115
Q

What is the age and sex preference for hemangiomas?

A

30-40y.o. and FEMALE PREFERENCE!

116
Q

T/F: Hemangiomas are asymptomatic unless they expand and cause cord compression.

A

True

117
Q

Where do we see hemangiomas most frequently?

A

Vertebral bodies, and calvarium (preferably the frontal bone)

118
Q

Which neoplasm will demonstrate accentuated vertical trabeculae on a single vertebra? What if it’s on multiple vertebrae?

A

Single-hemangioma, or paget’s

Multiple-osteoporosis

119
Q

T/F: Hemangiomas will present with a honey-comb appearance on CT.

A

False: honey-comb/corduroy/accordion on XRAY

on CT, it’s the ‘polka-dot appearance’

120
Q

What is the peak incidence age for chondroblastomas?

A

5-25y.o.

121
Q

Are chondroblastomas more common in males or females?

A

Males

122
Q

Which painful, benign lesion likes to be in the apophyses or epiphyses?

A

Chondroblastoma

123
Q

What is the most common age for seeing fibrous cortical defects? Peak age?

A

Common 2-10y.o. w/ peak from 7-8y.o.

124
Q

How can you tell an osteoid osteoma from a fibrous cortical defect?

A

AGE!
FCD-2-10
OO is from 10-25

125
Q

T/F: Bone packing is a frequent treatment for fibrous cortical defects.

A

False: They spontaneously regress

126
Q

T/F: Nonossifying fibromas are usually seen eccentrically in the metadiaphyseal region of lower extremity long bones.

A

True

127
Q

Are non-ossifying fibromas painful?

A

No

128
Q

What is a fibroxanthoma?

A

The easy cheat if you can’t discern whether it’s a non-ossifying fibroma, a fibrous cortical defect, or fibrous dysplasia

129
Q

What is the age preference for fibrous dysplasia lesions?

A

0-20y.o.

130
Q

Polyostotic fibrous dysplasia with endocrine dysfunction and café-au-lait spots?

A

McCune Albright Syndrome

131
Q

Which lesion will you see the ‘rind sign’ with?

A

Fibrous dysplasia; thickened rim of sclerosis somewhere around the lesion (doesn’t have to be symmetrically thickened)

132
Q

What is the age and sex preference for Paget’s?

A

Males, elderly (I’m confused by his stats so over 55 or 85 y.o.)

133
Q

What are the phases of Paget’s?

A
  1. Lytic phase where bones architecture is lost
  2. Mixed between lytic & blastic
  3. Blastic phase but bone being laid down has so structure so it’s soft and weak
  4. Malignant degeneration (rare though)
134
Q

Where does Paget’s like to be?

A

Pelvis, vertebra, skull, proximal femur (& other long bones)

135
Q

In the long bones, how does Paget’s progress?

A

Starts subarticular and works towards the diaphysis

136
Q

Word association: Osteoporosis circumscripta

A

Paget’s; well defined lysis of frontal and occipital regions

137
Q

What can be a first sign that someone may have Paget’s affecting the skull?

A

Hat doesn’t fit due to cortical expansion; important b/c blastic mets on the skull look similar to Pagets but blastic mets have NO cortical reaction.

138
Q

Word association: Candle flame or blade of grass sign?

A

Paget’s; lytic edge usually affecting long bone cortex

139
Q

What is the ‘rim sign’?

A

Thickening of the iliopectineal line of the pubic bones; associated w/ Paget’s

140
Q

T/F: The picture frame vertebra (& eventual ivory vertebra) are part of the lytic phase of Paget’s.

A

False: blastic phase

141
Q

What’s the difference between a vertebral hemangioma and Paget’s affecting a vertebra?

A

Hemangiomas & Paget’s both have accentuated vertical trabecular but Pagets will also have cortical thickening around the body

Diagnostic Imaging COPY 515 (6 decks)

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