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Di Imaging 2 > Final > Flashcards

Final Flashcards

1
Q

What is does plastic rags correlate with?

A

The etiologies that may cause an avascular necrosis

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2
Q

PLASTIC RAGS

A 
Pancreatitis, pregnancy
Lupus
Alcoholism, atherosclerosis
Steroids
Idiopathic, infection
Caisson disease, collagen disease
Rheumatoid arthritis, radiation
Amyloid
Gaucher disease 
Sickle cell disease, spontaneous
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3
Q

4 stages of ANV

A

Avascular (death of bone)
Revascularization (angiogenesis, creeping substitution, fibrosis, cystic changes, bony fragmentation)
Repair/remodel
Deformity

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4
Q

AVN has affinity for what area of bone

A

Epiphyseal

Femur and humeral head**

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5
Q

Radiographic findings of AVN

A

-Collapse of articular cortex (loss of smooth contour/flattening and impaction fracture)
-fragmentation
-mottled trabecular pattern (thick over AVN)
-sclerosis
-subcontractors cysts
-subchondral fractures
(***crescent sign aka rim sign)

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6
Q

Chandler’s disease

A

AVN of femoral head in adults

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7
Q

XRAY findings of chandler’s disease

A
  • Crescent/rim sign (thin radiolucency at super weight bearing cortex)
  • Bite sign- wedge shaped necrotic area at anterior superior margin
  • Snow cap sign (dense spot
  • fragmentation/impaction FD
  • sclerosis/cystic changes
  • mottled bone density
  • Mushroom deformity
  • MRI shows decreased intensity
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8
Q

XRAY findings of healed chandler’s disease

A 
Articular deformity
Hanging rope sign- thing sclerotic line transverses femoral neck
Trochanteric overgrowth (greater trochanter should NOT be above femoral head)
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9
Q

Leg calve perthes disease

A

AVN of femoral capital epiphysis in kid before closure of growth plate

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10
Q

XRAY findings in leggings calve perthes disease

A

ST swelling(increased TDD- normal 9-11mm)
Small epiphysis
Lateral displacement of ossification center
Small obturator foramen
Flattening/fissuring of ossification center
Widened physis

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11
Q

DDX of legg calve perthes disease

A

Congenital hip dysplasia (check for putt is triad—small epiphysis, lateral femur displacement, and increased acetabular angle)
SCFE-use klines line(doesnt pass through metaphysis)

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12
Q

Osteochondrosis dessicans

A

Focal subchondral infarction (AVN) of sub-articular bone

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13
Q

Where is osteochondrosis dessicans MC? Age?

A

Knee (lateral aspect of medial femoral condole)

11-20

MC in Males

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14
Q

Akas for avascular necrosis

A

Osteonecrosis

Osteochondrosis

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15
Q

Is there decreased joint space with an AVN?

A

No.

If decreased—> Ddx DJD

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16
Q

Whats bone/marrow death called at epiphysis? Metaphysis? Diaphysis?

A

E: ANV

M/D: bone infarction

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17
Q

What is an AVN in the femoral head in a child called? Adult?

A

Child: leg calve perthes
Adult: chandlers

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18
Q

Stats on leg calve perthes

A

Mc 4-8years
5:1 boys

S/s groin pain, limping, decreased ROM

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19
Q

XRAY findings during avascular phase of LCP? (0-12months)

A

Capsular distention
Increased joint space
Increased tear drop distance
Small epiphysis

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20
Q

XRAY findings during revascularization of LCP

A 
Flat, small epiphysis
Fragmentation
Snow cap (sclerosis)
Increased cortical density
Metaphyseal cysts
Crescent sign 
Wide short femoral neck
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21
Q

MC areas for osteochondrosis dissecans

A
  • Knee (lateral aspect of medial femoral condyle 85%)
  • humeral head
  • capitellum of elbow
  • talus (medial aspect of talar dome)
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22
Q

XRAY of osteochondrosis dissecans

A
  • concave radiolucent defect <2cm

- may detach—>l joint mouse

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23
Q

Spontaneous osteonecrosis

A

-idiopathic AVN of the aged knee

Associated with medial meniscal lesions!

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24
Q

Osgood schlatter’s

A

Fragmentation of the apophysis of the tibial tuberosity

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25
Q

XRAY/diagnosis of osgood schlatter’s

A

Clinical

Localized pain, tenderness and swelling over tibial tuberosity.

**fragmentation may be normal. Requires pain/swelling to diagnose

11-15yrs

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26
Q

Ddx of osgood schlatter’s on XRAY

A
  • normal-separate ossification centers
  • avulsion Fx-involve entire tubercle
  • sindig-larsen-Johansson-involve inferior pole of patella too
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27
Q

Sindig-Larsen-johanssen

A

Fragmentation of apophysis of tibial tuberosity

+

Involved inferior pole of the patella

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28
Q

MRI for osgood schlatter’s

A

Dark T1
Bright T2

(Edema)

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29
Q

Freiburgs disease

A

AVN of metatarsal head

MC 2nd
MC F 13-18 (heels?)

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30
Q

XRAY of freiburgs

A

AVN of metatarsal head
Collapse of articular surface (concave).
Density/cystic changes

Joint fine—end of bone is not.

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31
Q

Keinbocks disease

A

AVN of lunate

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32
Q

Stats of keinbocks disease

A

20-40

MC in manual labor jobs and males

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33
Q

Keinbocks disease is associated with what

A

Negative ulnar variance (short ulna)

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34
Q

XRAY of keinbocks

A

AVN of lunate

-Negative ulnar variance
-Initially increased density then…
-Flattening, collapse, fragmentation
(Sclerotic/lucent changes)

-Unsure—> MRI—> low signal= AVN

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35
Q

May see signet ring with keinbocks disease which may be Ddx for what? And what’s the difference

A

Ddx: rotators subluxation of the scaphoid.

It is NOT RSS because there is no terry Thomas sign seen (increased distance)

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36
Q

Kohler’s disease

A

AVN of tarsal navicular

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37
Q

Kohler’s disease Ddx?

A

Normal

Increased density may be normal during development. Compare to other side. If no pain=Normal
If pain=kohler’s

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38
Q

XRAY of kohler’s

A 
Flat
Small
Dense 
Homogenous sclerosis
Collapse/fragmentation
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39
Q

Scheuermann’s disease. Etiology?

A

Likely trauma

Most likely not necrosis

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40
Q

Scheuermanns disease

A

Abnormality of discovertebral junction

Must include 3 continuous vertebra

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41
Q

XRAY of scheuermanns

A

T and L spine

  • Anterior body wedging
  • irregular end plates
  • decreased disc space
  • increased kyphosis
  • schmorl’s nodes
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42
Q

Juvenile discogenic disease

A

T-L scheuermann’s disease

Does not required 3 continuous vertebra

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43
Q

Inactive vs active scheuermanns

A

Inactive- done growing

Active-still growing

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44
Q

Severs disease

A

Sclerosis/fragmentation of calcaneal apophysis

***represents normal anatomy

-if pain—> calcaneal apophysitis

45
Q

Calcified medullary infarct

A

Serpiginous region of calcification within the medullary region of bone

Usually due to arteriosclerosis

46
Q

Ddx of calcified medullary infarct

A

Chondrosarcoma (PAIN)

Enchondroma

47
Q

Sickle cell disease

A

Genetic disorder affecting RBC
MC hemolytic anemia
MC in AA

Sickle shaped blood leads to hypoxia, AVN, retarded growth and marrow hyperplasia

48
Q

People with sickle cell disease are predisposed to what infections

A

Salmonella osteomyelitis infections

49
Q

XRAY findings of sickle cell anemia

A
  • Lincoln log/H shaped vertebra
  • hair on end skull
  • osteopenia
  • marrow hyperplasia (widened diploid space)
  • coarseness trabeculation
  • long bone under-tabulation (Erlenmeyer flask deformity)
50
Q

Thalassemia

A

Genetic RBC disorder causing abnormal hemoglobin

Presents with fatigue, splenomegaly, cardiomegaly and gallstones

51
Q

XRAY of thalassemia

A
  • marrow hyperplasia
  • extramedullary hematopoiesis
  • maxillary overgrowth (rodent facies)
  • hair on end skull
  • widened diploic space)
  • coarseness honeycomb trabeculation
  • erlenmeyer flask deformity
  • osteopenia
52
Q

Honeycomb coarsened trabeculation-what and with what

A

With thalassemia
Cystic changes to bones of hand

Osteopenia/thin cortex
Accentuated trabeculation

53
Q

Hemophilia

A

X chromosome bleeding disorder

Females carry but it manifests in men

54
Q

XRAY of hemophilia

A
  • radiodense effusion
  • osteopenia
  • square femoral condyles
  • epiphyseal overgrowth
  • wide inter articular notch
  • irregular juxta-articular surfaces and swelling
55
Q

Wide intercondylar notch and irregular juxta-articular surfaces with epiphyseal overgrowth

A

Hemophilia

56
Q

Leukemia

A

Malignant proliferation of WBC’s

57
Q

XRAY of leukemia

A
  • radiolucent su metaphyseal bands
  • osteopenia
  • osteolytic destruction of long bone metaphysis and diaphysis
  • periosteal Rx
  • growth arrest lines
58
Q

What may su metaphyseal bands be seen in?

A

Neuroblastoma
Scurvy
Syphilis
Severe systemic diseases

59
Q

Cellulitis

A

Infection of skin, subcutaneous fat or connective tissue

60
Q

Osteomyelitis

A

Infection of bone or marrow spaces

61
Q

Septic arthritis

A

Infection of joint/synovial tissue and articular surfaces

62
Q

MC organism for infection

A

Staph Aureus

63
Q

MC route of dissemination for infection

A

Hematogenous

64
Q

Drug addicts and areas of infection MC

A

“S joints”

Spine
SI
Symphysis pubis
Sternoclavicular

65
Q

Infant/young adults vs adults in onset of infections

A

Infant/young adult: acute process

Adults: insidious

66
Q

Infantile pattern of infection

A

Metaphyseal & diaphyseal vessels penetrate the physis (through GP)

Septic arthritis and osteomyelitis

67
Q

Childhood pattern of infection

A

Metaphyseal vessels do not penetrate physis. Separate epiphysis blood supply.

= tend to spare epiphysis and joint (osteomyelitis)

68
Q

Adult pattern of infection

A

Metaphyseal vessels penetrate the vanishing physis re-establishing connection with subarticular bone (through the growth plate)

=osteomyelitis and septic arthritis

69
Q

Most common locations for infection

A

Venous stasis areas

Knee
Hip
Ankle (distal tibia)
Shoulder
Spine
70
Q

Infections infect the joint in what age categories and spare the joint in what age categories?

A

Infect the joint aka: septic arthritis and osteomyelitis
Infant and adult

Infect only bone aka osteomyelitis
Children

71
Q

Two types of infections

A

Suppurations (pus) -staph

Non-suppurative - TB

72
Q

Suppurative osteomyelitis

A

Bone marrow infection by any nonTB organism.

MC Staph Aureus

73
Q

XRAY findings for latent (1-10 days) of infection

A

Little to no radiographic findings

ST edema
Osteopenia

74
Q

XRAY findings at early stage of infection (10-21 days)

A
  • ST swelling

- osteopenia

75
Q

XRAY findings for middle stage infection (weeks)

A
  • moth-eaten/permeating destructive changes—that may cross anatomical border
  • periosteal rx
76
Q

Xray findings for late stage infections (months)

A
  • cortical destruction
  • sclerosis
  • cloaca
  • sequestrum
  • ankylosis
  • involucrum
  • loss of joint space
77
Q

Xray findings for septic arthritis (joint-synovial/articular surfaces)

A 
Joint effusion
Osteoporosis
Erosions
Joint space loss
Lytic destruction that crosses joint space
78
Q

Sequestrum

A

Chalky white area representing isolated dead bone

Cortical and medullary infarcts

79
Q

Involucrum

A

Chronic periosteal rx where pus lifts the periosteum and causes new bone formation to try to wall off the infection

Lytic and destructive changes

80
Q

Cloaca

A

Opening in an involucrum where a squamous cell carcinoma can develop —> marjolin’s ulcer

Common in feet of diabetic

81
Q

Bony collar

A

Chronic periosteal response

Seen with infections and involucrum

82
Q

Marjolin’s ulcer

A

Squamous cell carcinoma within the channel of a cloaca during an infection

83
Q

Brodies abscess

A

-localized intro osseous abcess with suppurative osteomyelitis

84
Q

S/s of Brodie’s abscess

A
  • local pain worse at night relieved by aspirin
  • likes metaphysis
  • nidus <1cm
85
Q

Ddx of Brodie’s abscess

A

Osteoid osteoma

Brodies: redness, fever, cross joint space

86
Q

MC location for Brodie’s abscess

A

Metaphysis

Distal tibia

87
Q

Spinal infection origin and progression in adults and in children

A

Child: start in the disc bc it’s still vascular and then spread to the vertebral bodies

Adults: starts in anterior vertebral endplates and then goes to the disc with vertebral collapse

88
Q

S/s of septic arthritis

A
  • joint effusion
  • juxta-articular osteoporosis
  • erosions
  • joint space loss
  • lytic destruction crossing joints
89
Q

Unilateral sacroilitis think? Order?

A

Infection

CBC and HLA-B27

90
Q

In spinal infections where is the most common

A

Lumbar spine

91
Q

S/s of spinal infection on xray

A

Increased RPI, RTI
-paraspinal like deflection
Psoas abscess
End plate and disc destruction

92
Q

Erosion at anterior vertebral body with ill defined end plates, only one joint and decreased disc height

A

Spondylodiscitis (bone and disc)

93
Q

Imaging for infections: plain film, nuclear scintigraphy, CT MRI

A

Plain: not sensitive. Takes 3-4 weeks for osteomyelitis

Nuclear scintigraphy: bone scan: very sensitive. Technetium. Positive within hours

CT: good for hard to see areas like spine, pelvis, sternum

MRI: best! More sensitive for bone marrow. Precedes bone scan.
Dark T1, Bright T2=infection
(NOT MODIC CHANGE THO)

94
Q

Osteomyelitis findings on an MRI

A

Dark T1

Bright T2

95
Q

Differentiating infection vs DDD

A

Bright T2 = infection

Dark T2= DDD

96
Q

What is the MC cause of infection-related death worldwide

A

TB

97
Q

Primary vs secondary TB

A

Primary= silent clinically
Secondary= disseminates from the lungs and can infect the spine
-T/L junction. Common to see in multiple levels bc it “drips” down the spine

98
Q

XRAY findings for TB

A

Similar to osteomyelitis but slow growth

  • affects multiple levels
  • paraspinal cold abscesses with calcification
  • calcified or obliterated psoas major
  • gibbous formation: acute kyphotic angle
99
Q

Infections

____usually affects one joint/level. ____ usually affects multiple levels

A

Staph Aureus (suppurative osteomyelitis)

TB

100
Q

Where does adult TB infection usually start

A

Anterior endplate region

101
Q

What is the earliest radiographic finding of TB

A

Disc space narrowing

102
Q

MRI findings with TB

A

Dark T1

Bright T2

103
Q

Gibbous formation. What is it and seen with what?

A

TB

An acute kyphotic angle created at the TL junction due to bony destruction

104
Q

Phemister’s triad

A

seen with TB septic arthritis

  • juxtarticular osteoporosis
  • marginal erosions
  • slow joint space loss (months/years)
105
Q

TB septic arthritis

A

Phemister’s triad

  • juxtarticular osteoporosis
  • marginal erosions
  • slow joint space loss (years)
106
Q

_______MC location in suppurative infection and _______MC location for TB

A

Extremities-non

Skeletal-TB

107
Q

_______ involves multiple levels with paraspinal cold abcess vs _______ only affects one level

A

TB/non-suppurative=multiple

Suppurative=one level

108
Q

______has slow progression of joint destruction whereas ______has a faster progression

A

TB/non-suppurative= slow

Suppurative= fast

109
Q

_______has a poorer response to therapies vs ________

A

TB/non-suppurative = poor (long term antibiotics)

Suppurative= good response to antibiotics

Di Imaging 2 (5 decks)

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