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DXI II > Exam 1: [Lecture] > Flashcards

Exam 1: [Lecture] Flashcards

1
Q

Skeletal metastasis Age

A

40+

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2
Q

Skeletal Metastasis Best Modality

A

X-ray: 30-50% loss before noticed
Bone Scan: 3-5% Sensitive
CT: Sensitive & Specific
MRI: shows ST & Marrow Involvement

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3
Q

Skeletal Metastasis Matrix

A

Osseous

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4
Q

Skeletal Metastasis Location

A

Axial Skeleton
Skull
Proximal Extremities

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5
Q

Skeletal Metastasis Lab Findings

A

Elevated:
ESR, CRP, PSA
Acid & Alkaline Phosphatase
Serum Ca2+ Levels (LYTIC PROCESS)

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6
Q

Skeletal Metastasis Metastasis Sites

A

From Lung, Kidney, Breast/Prostate

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7
Q

MC form of spread in Skeletal metastasis

A

Hematogenous Dissemination

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8
Q

Metastatic Lesions Matrix

A

Bubbly

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9
Q

Metastatic Lesions Density

A

75% Lytic
15% Blastic
Mixed: Cookie-Bite Lesion

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10
Q

Types of Osteolytic Changes

A

Geographic
Moth-Eaten
Permeative

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11
Q

Patterns in Cartilaginous Matrix

A

Stippled
Arcs & Rings
Flocculent

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12
Q

Osseous Matrix

A

Bright White
Dense/Mature-Looking Bone

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13
Q

Types of Fibrous Matrix

A

Hazy
Smoky
Ground Glass

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14
Q

You can Identify a Fatty Matrix by…

A

Central Calficication

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15
Q

Indiscernible Matrix

A

Lacks Mineralization
Looks like a Lytic Lesion

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16
Q

Types of Solid Periosteal Reactions

A

Thin
Thick
Cortical Buttressing

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17
Q

4 Types of Periosteal Reactions

A

Solid
laminated
Speculated/Sunburst
Cod man triangle

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18
Q

5 Types of Cortical Involvement

A

Expansion
Endosteal Scalloping
Thinning
Destruction
Saucerization

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19
Q

When does a Soft Tissue Mass Occur?

A

When a lesion breaks through the host bone.
Distorts Facial Planes

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20
Q

MRI Overview

A

Non-Ionizing
Better ST contrast than CT
Based on Hydrogen Content

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21
Q

Tissue Color in MRI

A

Hyperintense (white)
Isointense (gray)
Hypointense (black)

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22
Q

MRI Sequences

A

T1
T2
STIR

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23
Q

T1 Weighted MRI

A

FAT Image (fat white)
Evaluates hemorrhage
Poor edema evaluation

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24
Q

T2 Weighted MRI

A

WATER Image (fluid white)
Good at detecting fluid, edema, malignancy, infections
Can miss marrow pathology

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25
Q

STIR MRI

A

VERY sensitive for Fluid, Edema, Marrow
Poor Resolution-Can’t use Contrast

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26
Q

MRI Contrast

A

Gadolinium (+C)

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27
Q

MRI IV Contrast

A

Highlights: Malignancy, tumor, infection, post-surgical back
[Includes precontrast & T1 postcontrast]

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28
Q

MRI Arthrography Contrast

A

Increases sensitivity for cartilage defects
Meniscus Tears
Shoulder/Hip Labrum’s
[Intra-articular injection]

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29
Q

MRI Contrast Contraindications

A

Pregnant
Renal Insufficiency
Hx of contrast reactions

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30
Q

CT Overview

A

Ionizing Radiation
Density of Tissue is measured

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31
Q

CT Densities

A

High Attenuation (white)
Low Attenuation (black)

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32
Q

4 Types of CT Contrast

A

Oral/Rectal: GI Tract
IV Iodine: Vascular Structures
Myelogram: Spinal canal
Arthrogram Iodine: intra-articular anatomy

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33
Q

CT Contraindications

A

Renal issues
Pregnant
Iodine allergy
Thyroid disease
Previous contrast reactions

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34
Q

Scintigraphy (Bone Scan) Overview

A

Shows metabolic activity of skeleton
(Osteoblastic Activity)
Technetium-99 (IV)

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35
Q

Bone Scan Used for:

A

Osseous metastasis
Occult fracture
Osteomyelitis

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36
Q

Bone Scan Contraindications

A

Pregnancy
Relatives: Breast-feeding, recent nuclear medicine scan

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37
Q

Most common malignancy of bone is

A

Metastatic Disease

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38
Q

Osseous metastasis is often seen in bones

A

That are rich in red marrow
(Axial Skeleton: Skull & Proximal extremities)

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39
Q

Primaries known to cause a real metastasis

A

Lung
Breast/Prostate
Kidney

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40
Q

3rd MC site of metastatic carcinoma

A

Osseous Metastasis

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41
Q

Most common pathway of metastatic spread

A

Hematogenous Dissemination

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42
Q

Signs & symptoms of Osseous Metastasis

A

Asymptomatic
Weight loss
Pain
Anemia
Fever

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43
Q

Osteolytic Lesions (Facts)

A

Osteoclast Activity
Usually from breast or Lung
Usually without periosteal reaction

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44
Q

Winking Owl Sign/Absent Pedicle is seen in

A

Osteolytic metastatic lesions
(Or VB collapse)

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45
Q

Suggestive pathologies of vertebra Plana

A

Metastatic Disease
Myeloma
Lymphoma
osteoporosis

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46
Q

DDx for Metastatic “Bubbly” OsteoLYTIC Lesions

A

[RATS]
Renal Cell carcinoma
Adrenal Carcinoma
Thyroid Carcinoma
Skin (melanoma)

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47
Q

Osteoblastic Lesions Metastasis Locations

A

[5 B’s Lick Pollen]
Bronchogenic
Breast
Bowel
Bladder
Brain
Lymphoma
Prostate

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48
Q

DDX for Ivory vertebrae

A

[IHOP]
Idiopathic
Hodgkin Lymphoma
Osteoblastic Metastasis
Paget Disease

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49
Q

Recommendations for Suspected Metastatic Disease

A

Chest X-ray
Bone scan for osseous lesions
CBC with differential & metabolic panel
MRI with and without contrast
PCP REFERRAL

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50
Q

Multiple Myeloma’s relationship with Plasma Cells

A

“Dyscrasia”- uncontrolled plasma cell and antibody production
Plasma cells produce antibodies

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51
Q

What disease has a local environment rich in inflammatory biochemistry (increased bone lysis & decreased bone production)

A

Multiple Myeloma

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52
Q

Multiple Myeloma Age/Gender

A

50-70
2:1 Male

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53
Q

Signs of Multiple Myeloma

A

Initial Symptom = (i) bone pain -> (c) bone pain
Weight loss
Osteoporosis
Pneumonia/other infections

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54
Q

Labs to Order for Multiple Myeloma

A

CBC with Differential
Serum Protein Electrophoresis
Complete Metabolic Panel
Urinalysis
Bone Marrow Biopsy

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55
Q

Lab results from Multiple Myeloma

A

Anemia
Thrombocytopenia (increased bleeding)
Hypercalcemia & Hyperuricemia
Elevated Plasma Proteins (reversed A:G ratio)
M-Spike on Serum Protein Electrophoresis
Bench Jones Proteinuria

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56
Q

Multiple Myeloma presents with

A

[CRAB]
Calcium elevation
Renal Disease
Anemia
Bone Pain

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57
Q

Location of Multiple Myeloma

A

MC in Vertebra, Ribs, Pelvis, Skull
Other: Proximal Femur & Humerus

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58
Q

3 Imaging Features seen in Multiple Myeloma

A

1) MC: Osteopenia
2) Multiple Punched out lesions
3) Rain Drop Skull

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59
Q

Best Modalities for Multiple Myeloma

A

MRI with marrow signal
CT helps define lesions
Bone Scan NOT BEST (decrease osteoblasts)
***Dx: Bone Marrow Biopsy

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60
Q

DDx for Multiple Myeloma

A

OsteoLYTIC Metastasis
Lymphoma

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61
Q

Symptoms and Age of Plasmacytoma

A

<50
Localized pain
Abnormal serum protein levels
Path Fracture Common

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62
Q

Location of Plasmacytoma

A

Mandible
Ilia
Vertebrae
Ribs
Prox. Femur
Scapula

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63
Q

Density of Plasmacytoma

A

LYTIC, geographic, expansile, soap bubble

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64
Q

FEGNOMASHIC is used for

A

Lytic Bone Lesions

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65
Q

FEGNOMASHIC Letters stand for:

A

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

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66
Q

MC Primary Lymphoma of Bone

A

NHL

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67
Q

What Lymphoma presents as a solitary bone lesion?

A

NHL

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68
Q

Age/Gender for NHL

A

20-40
2:1 Male

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69
Q

Symptoms with NHL

A

(I) localized pain: dull, achy, rest doesnt help

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70
Q

Location of NHL

A

Diaphysis or Metadiaphysis
[Axial]: Spine, pelvis, Scapula (VB)

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71
Q

Imaging Features of NHL

A

LYTIC (maybe sclerotic)
Laminated PR
Large ST Mass

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72
Q

DDx of NHL

A

Young pt: Osteosarcoma, Ewing, Osteomyelitis, leukemia
Old pt: Metastasis, MML, Infection, Fibrosarcoma

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73
Q

Age/Gender in Hodgkin Lymphoma

A

10-35 AND >55
Males

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74
Q

Location of Hodgkin Lymphoma

A

T/L Spine
MC site: VB

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75
Q

Imaging Features of Hodgkin Lymphoma

A

Lytic 75%
Sclerotic 15% (ivory vertebrae, ant. Scalloping)
Mixed 10%

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76
Q

DDx for Osteoblastic Hodgkin Lymphoma

A

Metastasis
Paget

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77
Q

DDx for Osteolytic Hodgkin Lymphoma

A

Metastasis
MML
Infection
Osteosarcoma
Ewing
Fibrosarcoma

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78
Q

Malignancy of marrow and blood

A

Leukemia

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79
Q

MC Malignant Childhood Disease

A

Acute Leukemia (2-5 y.o.)
MC: Acute Lymphocytic Leukemia

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80
Q

Signs of Childhood Leukemia

A

Lymphadenopathy
Splenomegaly
Elevated ESR

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81
Q

Imaging Features of Childhood Leukemia

A

Osteopenia (trabecular reabsorption)
LYTIC
Periosteal Response: Laminated
Wide medullary space
Thinning cortices

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82
Q

DDx for Childhood Leukemia

A

Scurvy or Rickets
Juvenile Chronic Arthritis
Focal Lesion? -> Ewing or Infections

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83
Q

Adult Leukemia Age/Gender

A

35-55
20% of adults

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84
Q

MC Radiographic appearance in Leukemia

A

Generalized Osteopenia

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85
Q

Osteoma Age/Gender

A

10-50
3:1 female

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86
Q

Osteoma can cause

A

Poor sinus drainage
Headaches
Cosmetic deformity

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87
Q

Osteoma’s Malignant Potential

A

NONE

88
Q

Triad of growth’s in Gardner Syndrome

A

Multiple Osteomas
Colonic Polyposis
ST Fibromas

89
Q

Gardner Syndrome Presentation

A

Autosomal Dominant
Several Fibromas Present
Bone Lesions seen before Polyps

90
Q

Giant Bone Islands

A

Enostoma (typically in pelvis) >1cm

91
Q

Osteoid Osteoma Appearance

A

Reactive Bone surrounds central fleck of calcification

92
Q

Osteoid Osteoma Age/Gender

A

10-25
2:1 Male

93
Q

Classic Pain of Osteoid Osteoma

A

Pain @ night relieved by aspirin
Other: limited ROM, limp, scoliosis on concave side

94
Q

Location of Osteoid Osteoma

A

MC: Proximal Femur
Tibia
10% in Neural Arch

95
Q

Imaging Qualities of Osteoid Osteoma

A

Solid PR
Cortical Thickening
Increased Sclerosis
Central Lucent Nidus

96
Q

DDx for solid periosteal reaction with cortical thickening or reactive sclerosis

A

Osteoid Osteoma
Stress Fracture
Brodie Abcess

97
Q

Bets Modality for Osteoid Osteoma

A

CT (see Nidus & fleck)
Bone Scan

98
Q

Osteoblastoma Age/gender

A

<20
2:1 Male

99
Q

Symptoms of Osteoblastoma

A

Aspirin may alleviate
Pain not always @ Night
Painful Scoliosis

100
Q

Location of Osteoblastoma

A

MC: [Spine] T/L region, Neural Arch
[Extremities]: Metaphysis or Diaphysis
Knee or Hip

101
Q

Osteoblastoma Imaging Features

A

LYTIC, bubbly, expansile
Cortical thinning

102
Q

DDx for Lesions affecting the posterior elements

A

ABC
GCT
Osteoblastoma
Osteochondroma
Osteoid Osteoma

103
Q

2nd MC Primary Malignancy of Bone & MC in Pediatric’s

A

Conventional Osteosarcoma

104
Q

Conventional Osteosarcoma Age/Gender

A

10-25
2:1 Male

105
Q

Location of Conventional Osteosarcoma

A

Metaphysis
MC: Femur by Knee

106
Q

Imaging Features of Osteosarcoma

A

50% Sclerotic, 25% Lytic, 25% Mixed
Long Zone of Transition
Speculated Codman’s Triangle PR
Cortical Destruction
ST Mass Common

107
Q

Cannon-Ball Metastasis

A

Osteosarcoma

108
Q

MC Benign bone tumor of the Hand

A

Enchondroma

109
Q

Short Bone Enchondroma Appearance

A

Lytic, geographic, expansile
NO PR

110
Q

Enchondroma Matrix

A

Cartilaginous
Stippled or Flocculent

111
Q

DDx for Short Bone Enchondroma

A

GCT
SBC
Fibrous Dysplasia
Chondroblastoma
Osteoblastoma

112
Q

Long Bone Enchondroma Appearance

A

Amorphous, flocculent calcification with possible radiolucency

113
Q

DDx for Long Bone Enchondroma

A

Infarct
Chondrosarcoma
Enchondroma

114
Q

Multiple Enchondromas

A

Enchondroma to sis
Ollier Disease

115
Q

Enchondromatosis + ST Hemangiomas =

A

Maffucci Syndrome

116
Q

Osteochondroma Facts

A

Tumor form “displaced cartilage”
In pt’s with open growth plates
Asymptomatic with palpable mass

117
Q

MC Primary Benign Bone Tumor

A

Osteochondroma

118
Q

Osteochondroma Appearance

A

Osseous outgrowth with cartilaginous cap

119
Q

Pedunculated Osteochondroma

A

“Stalk”
Points away from the nearest joint

120
Q

Sessile Osteochondroma

A

“Hill” or “mound”

121
Q

Osteochondroma Complications

A

Fracture
Bursitis
Deformity
Vascular Injury
Neurological Injury
Malignant Degeneration

122
Q

Multiple Osteochondroma =

A

HME

123
Q

HME Facts

A

Autosomal Dominant
2-10 years
“Brahman Bull” appearance
Broad Metaphysis

124
Q

Chondroblastoma Age/Gender

A

10-25
2:1 Male

125
Q

Location of Chondroblastoma

A

MC in long bones around Knee & Shoulder
Epiphyseal & Apophyseal

126
Q

Chondroblastoma Characteristics

A

Eccentric, Geographic, Expansile, Radiolucent
Stipple/Flocculent
Medullary
Juxta-Articular
Thin Sclerotic Border
Physical Insult & Path Fracture

127
Q

2nd MC Benign Tumor of the Patella

A

Chondroblastoma

128
Q

Malignant Tumor formed of Cartilage cells

A

Chondrosarcoma

129
Q

Conventional Chondrosarcoma Age/Gender

A

40-60
2:1 Male

130
Q

Conventional Chondrosarcoma Location

A

MC in Pelvis & Proximal Femur
MC in Metaphysis and Diaphysis
Ribs
Proximal Humerus
Scapula

131
Q

Imaging Qualities of Conventional Chondrosarcoma

A

Poorly Defined
Long Zone of Transition
Cortical Destruction
PR
Endosteal Scalloping
Large ST Mass

132
Q

Conventional Chondrosarcoma Matrix

A

Arcs & Rings or Flocculent

133
Q

Conventional Chondrosarcoma DDx

A

Metastasis
Enchondroma
Osteosarcoma
Lymphoma

134
Q

Clear Cell Chondrosarcoma Imaging Characteristics

A

Epiphyseal lesion
Geographic, LYTIC, Expansile (slightly)
Cortical THinnign

135
Q

DDx’s for Clear Cell Chondrosarcoma

A

Chondroblastoma
GCT
ABC

136
Q

Cause of Fibrous Cortical Defect

A

Faulty Ossification or local trauma to periosteum

137
Q

Clinical Features/Age/Gender for Fibrous Cortical Defect

A

4-8
2:1 Male (40% of normal kids)
Asymptomatic
No Malignancy Possible

138
Q

Fibrous Cortical Defect Location

A

MC: Distal Femur (posteromedial aspect)
Tibia, Fibula, Proximal Femur/Humerus, Ribs, Ilium
Metaphyseal

139
Q

Fibrous Cortical Defect Imaging Features

A

Focal, Superficial Lucent area of cortex of Metaphysis
Well-Defined borders
Larger lesions may have multiloculated look
Migrate toward Diaphysis

140
Q

Non-Ossifying Fibroma Clinical Features/Age/Gender

A

8-10
2:1 Male
Asymptomatic
No Malignancy

141
Q

Location of Non-Ossifying Fibromas

A

MC: Distal Tibia
Proximal tibia, Distal Femur, Fibula, Proximal Humerus
Metadiaphyseal

142
Q

Non-Ossifying Fibroma Imaging Features

A

Lytic, Eccentric, Geographic
Scalloped/Lobuylated Borders
Sclerotic Rim
Thin Cortical Edge
Multiple Lesions Possible

143
Q

Non-Ossifying Fibroma is associated with

A

Neurofibromatosis Type 1

144
Q

Fibrosarcoma Age/Gender/Symptoms

A

30-50
M=F
Limited ROM
Path Fracture (1/3)

145
Q

Fibrosarcoma Location

A

Young pt: Long Bones
[Metaphyseal] Femur, Tibia, Humerus
Older pt: Flat Bones
Skull, Facial bones

50% about the knee

146
Q

Fibrosarcoma Imaging features

A

LYTIC, expansile, eccentric
Cortical thinning
Endosteal erosion
ST mass
May lack PR

147
Q

Secondary Fibrosarcoma occurs in what pre-existing conditions?

A

Fibrous Dysplasia
Paget
Post-Radiation Treatment
Chronic Osteomyelitis
Bone Infarct

148
Q

Metastasis of Fibrosarcoma

A

Through Lymphatic System
Lung & Liver

149
Q

Giant Cell Tumor Age/Gender/Symptoms

A

20-40
Female more benign
Achy pain & swelling, limited ROM

150
Q

Giant Cell Tumor Location

A

50% Knee
Distal femur, Radius
Proximal Tibia, Humerus
MC Spinal Site: Sacrum
[Metaphyseal] extends to Diaphysis

151
Q

MC Benign tumor of the Patella

A

Giant Cell Tumor

152
Q

Giant Cell Tumor Imaging Features

A

Lytic, geographic, eccentric
Sub articular extension
Sharp Zone of Transition
No Sclerotic Border
Soap Bubbly

153
Q

GCT of the spine

A

Involves VB with extension to posterior elements

154
Q

Simple Bone Cyst Age/Gender/Symptoms

A

3-14
2:1 Male
Asymptomatic

155
Q

Simple Bone Cyst Location

A

75% @ proximal Humerus or Femur
Metaphyseal in long bones

156
Q

Simple Bone Cyst Imaging Features

A

Lytic, geographic
Soap bubbly
Centrally located in Metaphysis
Critical thinning
Mile osseous expansion

157
Q

What is an Aneurysmal Bone Cyst?

A

Not a neoplasm
Cystic cavity in bone filled with blood

158
Q

ABC Age/gender/Symptoms

A

5-20
60% female
Acute onset of pain w/ rapid increase in severity
Path fracture

159
Q

ABC Location

A

MC: Femur & Tibia (eccentric, Metaphyseal)
MC in Spine: T/L posterior arch

160
Q

ABC Imaging features

A

Lytic, geographic, expansile
Periosteal buttressing

161
Q

Intraosseous Lioma Facts/Age/Gender

A

Mature Adipocytes
30-40
M = F

162
Q

Intraosseous Lipoma MC’s

A

RAREST Primary Benign Bone Tumor
MCly Asymptomatic

163
Q

Intraosseous Lipoma Imaging Features

A

Lytic, geographic
Central calcification fleck “target sequestrium”
No Malignant Potential
Path fracture

164
Q

MC Benign Tumor of the Spine

A

Hemangioma

165
Q

Hemangioma Age/Gender/ Symptoms

A

After 40
F>M
Asymptomatic
(May have pain & muscle spasm)

166
Q

Hemangioma Location

A

Spine 50%: VB, T/L
Skull 20%: Frontal Bone

167
Q

What Lesion has a high intensity on both T1 and T2 MRI Images?

A

Hemangioma

168
Q

Multiple vs Single Hemangioma DDx

A

Multiple: Osteoporosis
Single: Paget

169
Q

4th MC Primary Malignancy of Bone & 2nd MC in Pediatric’s

A

Ewing

170
Q

Ewing Sarcoma Age/Gender/Symptoms

A

10-25
2:1 Male
Pain with swelling
Palpable ST mass

171
Q

Ewing Sarcoma Location

A

MC: Femur & Tibia
MC: Diaphyseal

172
Q

Ewing Sarcoma Imaging Features

A

Lytic or Mixed
Moth-Eated/Permeative
Cortical Saucerization
Long Zone of Transition
ST Extension
Laminated PR

173
Q

Ewing Sarcoma Metastasis Sites

A

Lungs & Bone

174
Q

Rare Malignant tumor of notochordal remnants

A

Chordoma

175
Q

What lesion creates a mass effect on surrounding structures?

A

Chordoma

176
Q

Chordoma Location/Age/Gender

A

40-70
2:1 Male
Sacrococcygeal
Sphenoid-Occipital
Spine (C2 MC)

177
Q

Sacral Chordoma DDx’s

A

GCT
Chondrosarcoma
Metastasis
Plasmacytoma

178
Q

Skull Chordoma DDx’s

A

Metastasis
Intracranial Tumor w/ osseous involvement
Chondrosarcoma

179
Q

Letterer-Siwe Facts

A

<3 years old
High fever, skin rash, hepatosplenomegaly, lymphadenopathy
Irregular Lytic lesion

180
Q

Hand-Schiller-Christian Facts

A

Classic triad: exophthalmos, Diabetes Insipidus, Lytic Skull Lesions
Lytic Lesions of skull: “hole-within-a-hole” “geographic skull”

181
Q

Eosinophilic Granuloma Age/Gender/Symptoms

A

<20
M=F
Localized pain & Swelling
Sometimes Neurological compromise

182
Q

Eosinophilic Granuloma Location

A

Skull
Mandible “Floating Teeth”
Pelvis
Spine (VB)
Diaphysis of Long Bones

183
Q

Imaging Features of Eosinophilic Granuloma

A

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

184
Q

Eosinophilic Granuloma (Skull & Mandible DDx’s

A

Dentigerous cysts, fibrous dysplasia

185
Q

Eosinophilic Granuloma (long bones & pelvis) DDx’s

A

Aggressive: Ewing, Infection, Lymphoma, osteosarcoma
Non-Aggresive: Chondroblastoma, FCD, NOF, Fibrous Dysplasia

186
Q

What is Paget Disease?

A

Tumor-like process of unknown origin
Osteolytic followed by attempts at repair

187
Q

Paget Disease Age/Gender/Symptoms

A

> 55
2:1 Male
90% Asymptomatic
MC Symptom: Dull Pain

188
Q

Paget Disease Lab Findings

A

Increased:
Serum Alkaline Phosphatase
Urinary Hydroxyproline

189
Q

Paget Disease Location

A

MC Axial Skeleton
(Been found in nearly every bone though)

190
Q

4 Stages of Paget Disease

A

I: Lytic
II: Mixed
III: Sclerotic
IV: Malignant Degeneration

191
Q

Stage I Paget Disease Characteristics

A

Osteoclast over-activity (lost bone density)
Well-Defined Lucent LEsion
May be Expansile

192
Q

Stage I Paget Disease (SKULL)

A

“Osteoporosis Circumscripta”
Geographic Reabsorption of Bone

193
Q

Stage I Paget Disease (LONG BONES)

A

“Flame-shaped” or “blade-of-grass” appearance

194
Q

Stage I Paget Disease (SPINE)

A

VB Collapse
Quick deposition o new bone as disease enters Stage II

195
Q

Stage II Paget Disease Characteristics

A

Most often seen clinically
Mixed
Critical Thickening
**Accentuation of Trabecular Patterns
Bony Enlargement
Cotton Wool Skull

196
Q

Stage III Paget Disease Characteristics

A

Uniform Thickening of Trabeculae
Increased Radiopacity/Density
Ivory Appearance (DDx: IHOP)
Picture-Frame Vertebrae’s
Brim Sign
Obliteration of Koehler teardrop

197
Q

Stage IV Paget Disease Characteristics

A

MCly to Osteosarcoma
Monostotic asymptomatic cases (less likely)
Polyostotic symptomatic cases (more likely)

198
Q

Paget Disease Complications

A

Deformity
Basilar Invaginatino
Pseudofractures
Spinal Stenosis
Anemia
Joint Degeneration
High Output Cardiac Failure

199
Q

MC Complication in Paget Disease

A

Path Fracture “banana-like”
MC in proximal third of Femur
Occurs in Stage II or Stage III

200
Q

What is Fibrous Dysplasia?

A

Normal marrow & cancellous bone are replaced by immature woven bone and dense fibrous tissue

201
Q

Fibrous Dysplasia Ages

A

Monostotic: 14
Polyostotic: 11
McCune Albright: 8

202
Q

MC Extraskeletal Manifestation in Fibrous Dysplasia

A

Cafe-au-lait spots
“Coast of Maine” appearance

203
Q

Monostotic Fibrous Dysplasia Location

A

MC: Proximal 1/3 Femur & Ribs
[Metadiaphysis]

204
Q

Monostotic Fibrous Dysplasia Imaging Features

A

Radiolucent, Loculated/Trabeculated
Ground-Glass (smoky)
Well Demarcated
Thick Sclerotic Border “rind”
Endosteal thinning/scalloping
“Long Lesion in a bone”

205
Q

Common Benign Rib Lesion (>4cm)

A

Fibrous Dysplasia

206
Q

Polyostotic Fibrous Dysplasia Imaging Features

A

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

207
Q

Fibrous Dysplasia Complicaitions

A

Shepherd’s Crook Deformity
Sarcomatous transformation

208
Q

McCune-Albright Syndrome

A

Polyostotic FD (unilateral)
Cafe-au-last spots
Endocrine Abnormalities

209
Q

Cherubim’s

A

Familial Fibrous Dysplasia of the Jaw
Autosomal Dominant

210
Q

Neurofibromatosis Type 1 Incidence & Tissues Involved

A

1:3000 births (60% w/ familial Hx)
Neuroectodermal & Mesodermal

211
Q

Neurofibromatosis Type 1 Clinical Features

A

Cafe-au-last spots (6+ is diagnostic)
Fibroma Molluscum
Elephant it is Neuromatosa
Focal Gigantism
Spine: Kyphoscoliosis & C1/C2 Subluxation

212
Q

Neurofibromatosis Type 1 Classic Triad

A

1) Cafe-au-lait spots
2) Fibroma Molluscum
3) Osseous Deformities

213
Q

Neurofibromatosis Type 1 Location

A

SKULL: vision, blindness, facial asymmetry, pulsating exophthalmos
SPINE: pain, motor symptoms, suboccipital headache, paraplegia

214
Q

Neurofibromatosis Type 1 Imaging Features

A

MC Kyphoscoliosis
Cervical Kyphosis
Posterior Vertebral Scalloping
Enlarged IVF’s & Macrocranium
Intrathoracic Memingoceles
Twisted Ribs
Orbital & Lambdoidal Defects
Multiple Non-Ossifying Fibromas
Focal Gigantism

215
Q

Neurofibromatosis Type 1 Complications

A

Malignant Degeneration (5%)

DXI II (8 decks)

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