Exam 1: [Lecture] Flashcards
Skeletal metastasis Age
40+
Skeletal Metastasis Best Modality
X-ray: 30-50% loss before noticed
Bone Scan: 3-5% Sensitive
CT: Sensitive & Specific
MRI: shows ST & Marrow Involvement
Skeletal Metastasis Matrix
Osseous
Skeletal Metastasis Location
Axial Skeleton
Skull
Proximal Extremities
Skeletal Metastasis Lab Findings
Elevated:
ESR, CRP, PSA
Acid & Alkaline Phosphatase
Serum Ca2+ Levels (LYTIC PROCESS)
Skeletal Metastasis Metastasis Sites
From Lung, Kidney, Breast/Prostate
MC form of spread in Skeletal metastasis
Hematogenous Dissemination
Metastatic Lesions Matrix
Bubbly
Metastatic Lesions Density
75% Lytic
15% Blastic
Mixed: Cookie-Bite Lesion
Types of Osteolytic Changes
Geographic
Moth-Eaten
Permeative
Patterns in Cartilaginous Matrix
Stippled
Arcs & Rings
Flocculent
Osseous Matrix
Bright White
Dense/Mature-Looking Bone
Types of Fibrous Matrix
Hazy
Smoky
Ground Glass
You can Identify a Fatty Matrix by…
Central Calficication
Indiscernible Matrix
Lacks Mineralization
Looks like a Lytic Lesion
Types of Solid Periosteal Reactions
Thin
Thick
Cortical Buttressing
4 Types of Periosteal Reactions
Solid
laminated
Speculated/Sunburst
Cod man triangle
5 Types of Cortical Involvement
Expansion
Endosteal Scalloping
Thinning
Destruction
Saucerization
When does a Soft Tissue Mass Occur?
When a lesion breaks through the host bone.
Distorts Facial Planes
MRI Overview
Non-Ionizing
Better ST contrast than CT
Based on Hydrogen Content
Tissue Color in MRI
Hyperintense (white)
Isointense (gray)
Hypointense (black)
MRI Sequences
T1
T2
STIR
T1 Weighted MRI
FAT Image (fat white)
Evaluates hemorrhage
Poor edema evaluation
T2 Weighted MRI
WATER Image (fluid white)
Good at detecting fluid, edema, malignancy, infections
Can miss marrow pathology
STIR MRI
VERY sensitive for Fluid, Edema, Marrow
Poor Resolution-Can’t use Contrast
MRI Contrast
Gadolinium (+C)
MRI IV Contrast
Highlights: Malignancy, tumor, infection, post-surgical back
[Includes precontrast & T1 postcontrast]
MRI Arthrography Contrast
Increases sensitivity for cartilage defects
Meniscus Tears
Shoulder/Hip Labrum’s
[Intra-articular injection]
MRI Contrast Contraindications
Pregnant
Renal Insufficiency
Hx of contrast reactions
CT Overview
Ionizing Radiation
Density of Tissue is measured
CT Densities
High Attenuation (white)
Low Attenuation (black)
4 Types of CT Contrast
Oral/Rectal: GI Tract
IV Iodine: Vascular Structures
Myelogram: Spinal canal
Arthrogram Iodine: intra-articular anatomy
CT Contraindications
Renal issues
Pregnant
Iodine allergy
Thyroid disease
Previous contrast reactions
Scintigraphy (Bone Scan) Overview
Shows metabolic activity of skeleton
(Osteoblastic Activity)
Technetium-99 (IV)
Bone Scan Used for:
Osseous metastasis
Occult fracture
Osteomyelitis
Bone Scan Contraindications
Pregnancy
Relatives: Breast-feeding, recent nuclear medicine scan
Most common malignancy of bone is
Metastatic Disease
Osseous metastasis is often seen in bones
That are rich in red marrow
(Axial Skeleton: Skull & Proximal extremities)
Primaries known to cause a real metastasis
Lung
Breast/Prostate
Kidney
3rd MC site of metastatic carcinoma
Osseous Metastasis
Most common pathway of metastatic spread
Hematogenous Dissemination
Signs & symptoms of Osseous Metastasis
Asymptomatic
Weight loss
Pain
Anemia
Fever
Osteolytic Lesions (Facts)
Osteoclast Activity
Usually from breast or Lung
Usually without periosteal reaction
Winking Owl Sign/Absent Pedicle is seen in
Osteolytic metastatic lesions
(Or VB collapse)
Suggestive pathologies of vertebra Plana
Metastatic Disease
Myeloma
Lymphoma
osteoporosis
DDx for Metastatic “Bubbly” OsteoLYTIC Lesions
[RATS]
Renal Cell carcinoma
Adrenal Carcinoma
Thyroid Carcinoma
Skin (melanoma)
Osteoblastic Lesions Metastasis Locations
[5 B’s Lick Pollen]
Bronchogenic
Breast
Bowel
Bladder
Brain
Lymphoma
Prostate
DDX for Ivory vertebrae
[IHOP]
Idiopathic
Hodgkin Lymphoma
Osteoblastic Metastasis
Paget Disease
Recommendations for Suspected Metastatic Disease
Chest X-ray
Bone scan for osseous lesions
CBC with differential & metabolic panel
MRI with and without contrast
PCP REFERRAL
Multiple Myeloma’s relationship with Plasma Cells
“Dyscrasia”- uncontrolled plasma cell and antibody production
Plasma cells produce antibodies
What disease has a local environment rich in inflammatory biochemistry (increased bone lysis & decreased bone production)
Multiple Myeloma
Multiple Myeloma Age/Gender
50-70
2:1 Male
Signs of Multiple Myeloma
Initial Symptom = (i) bone pain -> (c) bone pain
Weight loss
Osteoporosis
Pneumonia/other infections
Labs to Order for Multiple Myeloma
CBC with Differential
Serum Protein Electrophoresis
Complete Metabolic Panel
Urinalysis
Bone Marrow Biopsy
Lab results from Multiple Myeloma
Anemia
Thrombocytopenia (increased bleeding)
Hypercalcemia & Hyperuricemia
Elevated Plasma Proteins (reversed A:G ratio)
M-Spike on Serum Protein Electrophoresis
Bench Jones Proteinuria
Multiple Myeloma presents with
[CRAB]
Calcium elevation
Renal Disease
Anemia
Bone Pain
Location of Multiple Myeloma
MC in Vertebra, Ribs, Pelvis, Skull
Other: Proximal Femur & Humerus
3 Imaging Features seen in Multiple Myeloma
1) MC: Osteopenia
2) Multiple Punched out lesions
3) Rain Drop Skull
Best Modalities for Multiple Myeloma
MRI with marrow signal
CT helps define lesions
Bone Scan NOT BEST (decrease osteoblasts)
***Dx: Bone Marrow Biopsy
DDx for Multiple Myeloma
OsteoLYTIC Metastasis
Lymphoma
Symptoms and Age of Plasmacytoma
<50
Localized pain
Abnormal serum protein levels
Path Fracture Common
Location of Plasmacytoma
Mandible
Ilia
Vertebrae
Ribs
Prox. Femur
Scapula
Density of Plasmacytoma
LYTIC, geographic, expansile, soap bubble
FEGNOMASHIC is used for
Lytic Bone Lesions
FEGNOMASHIC Letters stand for:
Fibrous dysplasia/Fibrous Cortical Defect
Enchondroma/Eosinophilic Granuloma
Giant Cell tumor
Non-Ossifying Fibroma
Osteoblastoma
Metastasis/Myeloma
ABC
SBC
Hyperparathyroidism
Infection/Infarction
Chondroblastoma/Chondromyxoid Fibroma
MC Primary Lymphoma of Bone
NHL
What Lymphoma presents as a solitary bone lesion?
NHL
Age/Gender for NHL
20-40
2:1 Male
Symptoms with NHL
(I) localized pain: dull, achy, rest doesnt help
Location of NHL
Diaphysis or Metadiaphysis
[Axial]: Spine, pelvis, Scapula (VB)
Imaging Features of NHL
LYTIC (maybe sclerotic)
Laminated PR
Large ST Mass
DDx of NHL
Young pt: Osteosarcoma, Ewing, Osteomyelitis, leukemia
Old pt: Metastasis, MML, Infection, Fibrosarcoma
Age/Gender in Hodgkin Lymphoma
10-35 AND >55
Males
Location of Hodgkin Lymphoma
T/L Spine
MC site: VB
Imaging Features of Hodgkin Lymphoma
Lytic 75%
Sclerotic 15% (ivory vertebrae, ant. Scalloping)
Mixed 10%
DDx for Osteoblastic Hodgkin Lymphoma
Metastasis
Paget
DDx for Osteolytic Hodgkin Lymphoma
Metastasis
MML
Infection
Osteosarcoma
Ewing
Fibrosarcoma
Malignancy of marrow and blood
Leukemia
MC Malignant Childhood Disease
Acute Leukemia (2-5 y.o.)
MC: Acute Lymphocytic Leukemia
Signs of Childhood Leukemia
Lymphadenopathy
Splenomegaly
Elevated ESR
Imaging Features of Childhood Leukemia
Osteopenia (trabecular reabsorption)
LYTIC
Periosteal Response: Laminated
Wide medullary space
Thinning cortices
DDx for Childhood Leukemia
Scurvy or Rickets
Juvenile Chronic Arthritis
Focal Lesion? -> Ewing or Infections
Adult Leukemia Age/Gender
35-55
20% of adults
MC Radiographic appearance in Leukemia
Generalized Osteopenia
Osteoma Age/Gender
10-50
3:1 female
Osteoma can cause
Poor sinus drainage
Headaches
Cosmetic deformity
Osteoma’s Malignant Potential
NONE
Triad of growth’s in Gardner Syndrome
Multiple Osteomas
Colonic Polyposis
ST Fibromas
Gardner Syndrome Presentation
Autosomal Dominant
Several Fibromas Present
Bone Lesions seen before Polyps
Giant Bone Islands
Enostoma (typically in pelvis) >1cm
Osteoid Osteoma Appearance
Reactive Bone surrounds central fleck of calcification
Osteoid Osteoma Age/Gender
10-25
2:1 Male
Classic Pain of Osteoid Osteoma
Pain @ night relieved by aspirin
Other: limited ROM, limp, scoliosis on concave side
Location of Osteoid Osteoma
MC: Proximal Femur
Tibia
10% in Neural Arch
Imaging Qualities of Osteoid Osteoma
Solid PR
Cortical Thickening
Increased Sclerosis
Central Lucent Nidus
DDx for solid periosteal reaction with cortical thickening or reactive sclerosis
Osteoid Osteoma
Stress Fracture
Brodie Abcess
Bets Modality for Osteoid Osteoma
CT (see Nidus & fleck)
Bone Scan
Osteoblastoma Age/gender
<20
2:1 Male
Symptoms of Osteoblastoma
Aspirin may alleviate
Pain not always @ Night
Painful Scoliosis
Location of Osteoblastoma
MC: [Spine] T/L region, Neural Arch
[Extremities]: Metaphysis or Diaphysis
Knee or Hip
Osteoblastoma Imaging Features
LYTIC, bubbly, expansile
Cortical thinning
DDx for Lesions affecting the posterior elements
ABC
GCT
Osteoblastoma
Osteochondroma
Osteoid Osteoma
2nd MC Primary Malignancy of Bone & MC in Pediatric’s
Conventional Osteosarcoma
Conventional Osteosarcoma Age/Gender
10-25
2:1 Male
Location of Conventional Osteosarcoma
Metaphysis
MC: Femur by Knee
Imaging Features of Osteosarcoma
50% Sclerotic, 25% Lytic, 25% Mixed
Long Zone of Transition
Speculated Codman’s Triangle PR
Cortical Destruction
ST Mass Common
Cannon-Ball Metastasis
Osteosarcoma
MC Benign bone tumor of the Hand
Enchondroma
Short Bone Enchondroma Appearance
Lytic, geographic, expansile
NO PR
Enchondroma Matrix
Cartilaginous
Stippled or Flocculent
DDx for Short Bone Enchondroma
GCT
SBC
Fibrous Dysplasia
Chondroblastoma
Osteoblastoma
Long Bone Enchondroma Appearance
Amorphous, flocculent calcification with possible radiolucency
DDx for Long Bone Enchondroma
Infarct
Chondrosarcoma
Enchondroma
Multiple Enchondromas
Enchondroma to sis
Ollier Disease
Enchondromatosis + ST Hemangiomas =
Maffucci Syndrome
Osteochondroma Facts
Tumor form “displaced cartilage”
In pt’s with open growth plates
Asymptomatic with palpable mass
MC Primary Benign Bone Tumor
Osteochondroma
Osteochondroma Appearance
Osseous outgrowth with cartilaginous cap
Pedunculated Osteochondroma
“Stalk”
Points away from the nearest joint
Sessile Osteochondroma
“Hill” or “mound”
Osteochondroma Complications
Fracture
Bursitis
Deformity
Vascular Injury
Neurological Injury
Malignant Degeneration
Multiple Osteochondroma =
HME
HME Facts
Autosomal Dominant
2-10 years
“Brahman Bull” appearance
Broad Metaphysis
Chondroblastoma Age/Gender
10-25
2:1 Male
Location of Chondroblastoma
MC in long bones around Knee & Shoulder
Epiphyseal & Apophyseal
Chondroblastoma Characteristics
Eccentric, Geographic, Expansile, Radiolucent
Stipple/Flocculent
Medullary
Juxta-Articular
Thin Sclerotic Border
Physical Insult & Path Fracture
2nd MC Benign Tumor of the Patella
Chondroblastoma
Malignant Tumor formed of Cartilage cells
Chondrosarcoma
Conventional Chondrosarcoma Age/Gender
40-60
2:1 Male
Conventional Chondrosarcoma Location
MC in Pelvis & Proximal Femur
MC in Metaphysis and Diaphysis
Ribs
Proximal Humerus
Scapula
Imaging Qualities of Conventional Chondrosarcoma
Poorly Defined
Long Zone of Transition
Cortical Destruction
PR
Endosteal Scalloping
Large ST Mass
Conventional Chondrosarcoma Matrix
Arcs & Rings or Flocculent
Conventional Chondrosarcoma DDx
Metastasis
Enchondroma
Osteosarcoma
Lymphoma
Clear Cell Chondrosarcoma Imaging Characteristics
Epiphyseal lesion
Geographic, LYTIC, Expansile (slightly)
Cortical THinnign
DDx’s for Clear Cell Chondrosarcoma
Chondroblastoma
GCT
ABC
Cause of Fibrous Cortical Defect
Faulty Ossification or local trauma to periosteum
Clinical Features/Age/Gender for Fibrous Cortical Defect
4-8
2:1 Male (40% of normal kids)
Asymptomatic
No Malignancy Possible
Fibrous Cortical Defect Location
MC: Distal Femur (posteromedial aspect)
Tibia, Fibula, Proximal Femur/Humerus, Ribs, Ilium
Metaphyseal
Fibrous Cortical Defect Imaging Features
Focal, Superficial Lucent area of cortex of Metaphysis
Well-Defined borders
Larger lesions may have multiloculated look
Migrate toward Diaphysis
Non-Ossifying Fibroma Clinical Features/Age/Gender
8-10
2:1 Male
Asymptomatic
No Malignancy
Location of Non-Ossifying Fibromas
MC: Distal Tibia
Proximal tibia, Distal Femur, Fibula, Proximal Humerus
Metadiaphyseal
Non-Ossifying Fibroma Imaging Features
Lytic, Eccentric, Geographic
Scalloped/Lobuylated Borders
Sclerotic Rim
Thin Cortical Edge
Multiple Lesions Possible
Non-Ossifying Fibroma is associated with
Neurofibromatosis Type 1
Fibrosarcoma Age/Gender/Symptoms
30-50
M=F
Limited ROM
Path Fracture (1/3)
Fibrosarcoma Location
Young pt: Long Bones
[Metaphyseal] Femur, Tibia, Humerus
Older pt: Flat Bones
Skull, Facial bones
50% about the knee
Fibrosarcoma Imaging features
LYTIC, expansile, eccentric
Cortical thinning
Endosteal erosion
ST mass
May lack PR
Secondary Fibrosarcoma occurs in what pre-existing conditions?
Fibrous Dysplasia
Paget
Post-Radiation Treatment
Chronic Osteomyelitis
Bone Infarct
Metastasis of Fibrosarcoma
Through Lymphatic System
Lung & Liver
Giant Cell Tumor Age/Gender/Symptoms
20-40
Female more benign
Achy pain & swelling, limited ROM
Giant Cell Tumor Location
50% Knee
Distal femur, Radius
Proximal Tibia, Humerus
MC Spinal Site: Sacrum
[Metaphyseal] extends to Diaphysis
MC Benign tumor of the Patella
Giant Cell Tumor
Giant Cell Tumor Imaging Features
Lytic, geographic, eccentric
Sub articular extension
Sharp Zone of Transition
No Sclerotic Border
Soap Bubbly
GCT of the spine
Involves VB with extension to posterior elements
Simple Bone Cyst Age/Gender/Symptoms
3-14
2:1 Male
Asymptomatic
Simple Bone Cyst Location
75% @ proximal Humerus or Femur
Metaphyseal in long bones
Simple Bone Cyst Imaging Features
Lytic, geographic
Soap bubbly
Centrally located in Metaphysis
Critical thinning
Mile osseous expansion
What is an Aneurysmal Bone Cyst?
Not a neoplasm
Cystic cavity in bone filled with blood
ABC Age/gender/Symptoms
5-20
60% female
Acute onset of pain w/ rapid increase in severity
Path fracture
ABC Location
MC: Femur & Tibia (eccentric, Metaphyseal)
MC in Spine: T/L posterior arch
ABC Imaging features
Lytic, geographic, expansile
Periosteal buttressing
Intraosseous Lioma Facts/Age/Gender
Mature Adipocytes
30-40
M = F
Intraosseous Lipoma MC’s
RAREST Primary Benign Bone Tumor
MCly Asymptomatic
Intraosseous Lipoma Imaging Features
Lytic, geographic
Central calcification fleck “target sequestrium”
No Malignant Potential
Path fracture
MC Benign Tumor of the Spine
Hemangioma
Hemangioma Age/Gender/ Symptoms
After 40
F>M
Asymptomatic
(May have pain & muscle spasm)
Hemangioma Location
Spine 50%: VB, T/L
Skull 20%: Frontal Bone
What Lesion has a high intensity on both T1 and T2 MRI Images?
Hemangioma
Multiple vs Single Hemangioma DDx
Multiple: Osteoporosis
Single: Paget
4th MC Primary Malignancy of Bone & 2nd MC in Pediatric’s
Ewing
Ewing Sarcoma Age/Gender/Symptoms
10-25
2:1 Male
Pain with swelling
Palpable ST mass
Ewing Sarcoma Location
MC: Femur & Tibia
MC: Diaphyseal
Ewing Sarcoma Imaging Features
Lytic or Mixed
Moth-Eated/Permeative
Cortical Saucerization
Long Zone of Transition
ST Extension
Laminated PR
Ewing Sarcoma Metastasis Sites
Lungs & Bone
Rare Malignant tumor of notochordal remnants
Chordoma
What lesion creates a mass effect on surrounding structures?
Chordoma
Chordoma Location/Age/Gender
40-70
2:1 Male
Sacrococcygeal
Sphenoid-Occipital
Spine (C2 MC)
Sacral Chordoma DDx’s
GCT
Chondrosarcoma
Metastasis
Plasmacytoma
Skull Chordoma DDx’s
Metastasis
Intracranial Tumor w/ osseous involvement
Chondrosarcoma
Letterer-Siwe Facts
<3 years old
High fever, skin rash, hepatosplenomegaly, lymphadenopathy
Irregular Lytic lesion
Hand-Schiller-Christian Facts
Classic triad: exophthalmos, Diabetes Insipidus, Lytic Skull Lesions
Lytic Lesions of skull: “hole-within-a-hole” “geographic skull”
Eosinophilic Granuloma Age/Gender/Symptoms
<20
M=F
Localized pain & Swelling
Sometimes Neurological compromise
Eosinophilic Granuloma Location
Skull
Mandible “Floating Teeth”
Pelvis
Spine (VB)
Diaphysis of Long Bones
Imaging Features of Eosinophilic Granuloma
Lytic, geographic, solitary
Endosteal scalloping
Solid or Laminets PR
Monostotic 3x > Polyostotic
SKULL: beveled edge, button sequestrum
MANDIBLE: floating teeth
SPINE: silver dollar, pancake, coin-on-edge
Eosinophilic Granuloma (Skull & Mandible DDx’s
Dentigerous cysts, fibrous dysplasia
Eosinophilic Granuloma (long bones & pelvis) DDx’s
Aggressive: Ewing, Infection, Lymphoma, osteosarcoma
Non-Aggresive: Chondroblastoma, FCD, NOF, Fibrous Dysplasia
What is Paget Disease?
Tumor-like process of unknown origin
Osteolytic followed by attempts at repair
Paget Disease Age/Gender/Symptoms
> 55
2:1 Male
90% Asymptomatic
MC Symptom: Dull Pain
Paget Disease Lab Findings
Increased:
Serum Alkaline Phosphatase
Urinary Hydroxyproline
Paget Disease Location
MC Axial Skeleton
(Been found in nearly every bone though)
4 Stages of Paget Disease
I: Lytic
II: Mixed
III: Sclerotic
IV: Malignant Degeneration
Stage I Paget Disease Characteristics
Osteoclast over-activity (lost bone density)
Well-Defined Lucent LEsion
May be Expansile
Stage I Paget Disease (SKULL)
“Osteoporosis Circumscripta”
Geographic Reabsorption of Bone
Stage I Paget Disease (LONG BONES)
“Flame-shaped” or “blade-of-grass” appearance
Stage I Paget Disease (SPINE)
VB Collapse
Quick deposition o new bone as disease enters Stage II
Stage II Paget Disease Characteristics
Most often seen clinically
Mixed
Critical Thickening
**Accentuation of Trabecular Patterns
Bony Enlargement
Cotton Wool Skull
Stage III Paget Disease Characteristics
Uniform Thickening of Trabeculae
Increased Radiopacity/Density
Ivory Appearance (DDx: IHOP)
Picture-Frame Vertebrae’s
Brim Sign
Obliteration of Koehler teardrop
Stage IV Paget Disease Characteristics
MCly to Osteosarcoma
Monostotic asymptomatic cases (less likely)
Polyostotic symptomatic cases (more likely)
Paget Disease Complications
Deformity
Basilar Invaginatino
Pseudofractures
Spinal Stenosis
Anemia
Joint Degeneration
High Output Cardiac Failure
MC Complication in Paget Disease
Path Fracture “banana-like”
MC in proximal third of Femur
Occurs in Stage II or Stage III
What is Fibrous Dysplasia?
Normal marrow & cancellous bone are replaced by immature woven bone and dense fibrous tissue
Fibrous Dysplasia Ages
Monostotic: 14
Polyostotic: 11
McCune Albright: 8
MC Extraskeletal Manifestation in Fibrous Dysplasia
Cafe-au-lait spots
“Coast of Maine” appearance
Monostotic Fibrous Dysplasia Location
MC: Proximal 1/3 Femur & Ribs
[Metadiaphysis]
Monostotic Fibrous Dysplasia Imaging Features
Radiolucent, Loculated/Trabeculated
Ground-Glass (smoky)
Well Demarcated
Thick Sclerotic Border “rind”
Endosteal thinning/scalloping
“Long Lesion in a bone”
Common Benign Rib Lesion (>4cm)
Fibrous Dysplasia
Polyostotic Fibrous Dysplasia Imaging Features
Bowing Deformities & path Fractures
More often Ground-glass looking
Pseudofractures occur on convex surface of bowing
Unilateral
Vertebral Involvement = RARE, if it does occur… L Spine (VB) MC, lacks ground glass, has rind of sclerosis
Fibrous Dysplasia Complicaitions
Shepherd’s Crook Deformity
Sarcomatous transformation
McCune-Albright Syndrome
Polyostotic FD (unilateral)
Cafe-au-last spots
Endocrine Abnormalities
Cherubim’s
Familial Fibrous Dysplasia of the Jaw
Autosomal Dominant
Neurofibromatosis Type 1 Incidence & Tissues Involved
1:3000 births (60% w/ familial Hx)
Neuroectodermal & Mesodermal
Neurofibromatosis Type 1 Clinical Features
Cafe-au-last spots (6+ is diagnostic)
Fibroma Molluscum
Elephant it is Neuromatosa
Focal Gigantism
Spine: Kyphoscoliosis & C1/C2 Subluxation
Neurofibromatosis Type 1 Classic Triad
1) Cafe-au-lait spots
2) Fibroma Molluscum
3) Osseous Deformities
Neurofibromatosis Type 1 Location
SKULL: vision, blindness, facial asymmetry, pulsating exophthalmos
SPINE: pain, motor symptoms, suboccipital headache, paraplegia
Neurofibromatosis Type 1 Imaging Features
MC Kyphoscoliosis
Cervical Kyphosis
Posterior Vertebral Scalloping
Enlarged IVF’s & Macrocranium
Intrathoracic Memingoceles
Twisted Ribs
Orbital & Lambdoidal Defects
Multiple Non-Ossifying Fibromas
Focal Gigantism
Neurofibromatosis Type 1 Complications
Malignant Degeneration (5%)
