Final Images Flashcards
what is this condition?
oseomyelitis
what are the arrows pointing to?
sequestrum = island of dead bone
what is noteable in the long bone?
involucrum = thick layer of periosteal new bone that forms around sequestrom
what is the opening from the bone to the skin called that may show up in this patient?
cloaca = opening in an involucrum that drains pus and debris out of infected bone
via sinus tract
patient presents with pain and swelling at joint
fever, chills
suspected infection
what do they probably have?
suppurative (pyogenic) osteomyelitis
photo: same patient, repeat xrays
what are these called?
what condition is this?
osteomyelitis
what is the left? what is the right
left: acute osteomyelitis
right: chronic osteomyelitis
what is this?
brodie abscess
what is this condition?
septic arthritis?
what is noted by the arrow here?
loss of joint space
what should be the ratio of the femoral-acetabular joint?
1:1:2
what is this?
septic arthritis
- marked and rapid joint space loss
- motheated or permeative destruction, complete resorption of articular end
- laminated periosteal response
- osseous or fibrous ankylosis
joint space loss
bone destruction
rapid over several weeks
what do you think this is?
septic arthritis
NOTE: upper extremity is uncommon
what is noted here?
what condition is this?
severe **disc space narrowing** endplate destruction (hazy, irregular)
Condition: Spondylodiscitis
infection involving disc and adjacent vertebral body
what patient usually gets this?
younger and older patients usually get spondylodiscitis
patients with this condition usually present with what?
spondylodiscitis = back pain
less often fever
what is the MC level(s) for spondylodiscitis?
single 65%
multiple contiguous 20%
what is this?
spondylodiscitis
how is this spread?
spondylodiscitis
hematogenously
what kind of deformity is this?
what kind of disease is this?
gibbus deformity
a form of structural kyphosis found typically in upper lumbar and lower throacic vertebra where 1+ adjacent vertebrae become wedged. most offten develops in children as a result of spinal TB and is the result of collapse of vertebral bodies.
pott disease
form of TB that occurs outside lungs and seen in vertebra
what ___% of TB is skeletal TB?
25-60% has Potts disease
slower than pyogenic spondylitis. lower thoracic and upper lumbar. begins at endplate. disc space loss is the earliest radiographic sign. lytic destruction 2-5 months.
what condition is this?
describe it
tubercular spondylitis, Pott’s disease
decreased disc space. loss of cervical curve. ??
what is this imaging modality?
what is this condition? why?
MRI and T1 weighted CSF/bone is dark and fat appears bright
tubercular spondylitis “Pott’s Disease”; ???
patient presents with insidious onsent of aching pain, stiffness, swelling, no lab changes.
Observation of crepitus, decreased ROM, palpable excrescences and adjacent mm atrophy.
what condition is this?
degenerative joint disease AKA osteoarthritis
MC joint disease and leading cause of disability
stiffness after rest that decreases with ~30 minutes of activity
name the radiographic findings of DJD
non-uniform joint space loss
osteophytes
suchondral sclerosis
subchondral cysts (geodes)
joint subluxation
intra-articular loos bodies
what is this?
DJD
what is this condition?
DJD
what is noted here?
uncovertebral joints
Small synovial articulations situated b/w the five lower cervical vertebral bodies. They are located anteromedially to the mixed nerve root and posteromedially to the vertebral artery, vein, and sympathetics as these pass through the vertebral foramen.
usually associated with IVD DJD
sharpening of uncinates first, then hypertrophic changes
what condition is this?
DJD
what condition is noted here?
DJD
what is noted here?
neurologic compromise 2˚ to DJD
what is this condition?
are patients asymptomatic / symptomatic?
Baastrup syndrome
“kissing spine” syndrome
associated with excessive lordosis and DDD
Both asymtpomatic and symptomatic patients
what is noted by the yellow?
subchondral cyst AKA geode
geographic, osteolytic lesion
what is noted by the green arrow?
decreased joint space
subchondral sclerosis
what condition is this?
DJD
which side is the lesion? and what is noted? what condition is it?
right side (reading left)
decreased superrior joint space, sclerosis, osteophytes
hip DJD
what is noted here?
sclerosis
osteophytes
knee DJD
what is this?
knee DJD
medial > lateral compartment changes
osteophytes, cysts, sclerosis and sharpening of tibial spines
osteochondral bodies are common
what is noted here? what sign is visible?
osteophytes at superiro and inferior poles
“tooth sign”
Patellofemoral DJD
what is this condition?
who woudl you refer this to?
patellofemoral DJD
surgeon to replace knee
what is this?
DJD
what is noted here?
non uniform joint space, soft tissue bump/nodule, osteophytes
MC DJD in in the DIPs
inflammatory at the PIPs
what is green?
what is blue?
Green: heberden nodes
Blue: bouchard nodes
what is this?
wrist DJD
osteophyte, sclerosis to name a few
what is visible here? what is the condition?
DJD
sclerosis
subluxation
loose body
what is noted here?
what view is this?
osteophyte
greater tuberosity
shoulder DJD
view: external rotation of shoulder
what is this?
treatment?
shoulder DJD
Tx: maint/ restore mobility (CMT, STM, rehab), nutritional support, NSAIDS, surgery may eventually be needed to replace joint
uncommon sites of DJD: ankle, GH, elbow, wrist (except 1st ray), MCP
if seen here, suspect 2˚ DJD
what condition is this?
who gets it?
erosive OA
females 30-50 yo
features of DJD and inflammatory arthritis. bilateral DIP and PIP involvement
what is noted by the blue?
green?
blue: “gull wing” sign
(severe DJD plus erosions = “gull wing” sign)
green: fused joint
what is this sign?
what is this condition?
“gull wing” sign
erosive osteoarthritis
what is condition?
what is the most involved part of the body?
DISH: Diffuse Idiopathic Skeletal Hyperostosis
Spinal and extraspinal ligaments and tendinous calcification and ossification. Especially ALL.
Thick, flowing hyperostosis anterior to the spine of 4 contiguous levels.
**NOTE: NORMAL disc spaces
what is this?
what is the most prominent Hx suggesting this conditoin?
DISH
Hx: stiffness
what is the different between DISH, DDD, AS, Psoriatic/Reactive?
DISH
- ossification: thick flowing at mid-body
- IVD: maintained
- Other: extraspinal enthesophytes
DDD
- non-marginal “claw”
- decreased
- –
AS
- thin, marginal
- maint or “ballooned”
- SI fusion early
P/R
- thick, non marginal
- maint
- some enthesopathy
What is this?
DISH extraspinal stuff
red and yellow arrows: rought areas of mm attachments
blue arrow: iliolumbar ligament calcification
what is this condition?
tx?
OPLL
tx: no specific. symptom-based, palliative. monitor for signs of central stenosis. conservative or surgical treatment for stenosis.
what is this conditoin?
6 Ds
Neuropathic arthropathy AKA Charcot joint
- *Di**stended
- *Di**slocation
- *Di**sorganization
- *De**nsity increase
- *De**struction
- *De**bris
patient presents with swollen, deformed joint. insidious painless onset. signs of peripheral neuropathy.
what is it?
neuropathic arthropathy AKA Charcot joint
similar to DJD but more rapid, more severe
what is this?
synovial chondromatosis
AKA osteochondromatosis, synoviochondrometaplasia
Pathology: metaplastic changes in synovium produce cartilaginous bodies that may (or may not) calcify or ossify
what is this?
who gets it?
most common location?
synovial chondromatosis
20-50 yo and M:F 3:1
MC location: elbow, hip 20%
DDX:
- osteochondritis dissecans = single osteochondral body + defect in host bone
- ossicles 2˚ to DJD
- neuropathic arthropathy AKA charcot joint
- pigmented villonodular synovitis (PVNS)
- normal sesamoids
what is this?
what is the MC inflammatory arthritis?
RA
it targets synovial tissues and joints, bilateral symmetry, progressive. affects 0.5-1% of the population.
affects articulations: wrist, hands, feet, shoulder, hip, knee, cervical spine
pathologic process: antigen-antibody complex depositive in synovium w/ resulting inflamm cascade. Synovial proliferation = pannus (hypertrophied vascular granulation tissue). Pannus erodes bone and articular cartilage.
what % of these patients get nodules?
20% rheumatoid nodules
what is this?
RA
- osseous erosion
- joint space loss
- bilateral symmetry
what is this?
Note: location
RA
Location: MCP and PIP. not DIPS
what is this?
RA
- bilateral
- wrist, mcp and pip involvement (NOT dip)
what is this?
Rheumatoid arthritis
- bilateral erosions
- no dip involvement
yellow arrows
red arrows
yellow: boutonniere
red: hitchhiker thumb
?
swan neck
what is this?
RA wrist
common things seen:
- tendinopathy is one of the earliest changes around wrist
- ulnar and radial styloid erosion
- “spotty carpal” sign
- uniform loss of radiocarpal joint
- scapholunate dissociation
what is this?
RA foot
- deformities e.g. hallux valgus
- poorly defined erosions at calcaneus
what is this?
how often is this location involved in this condition?
RA Spine
cervical spine involvement in 50-80%
- C1-2 instability
- facet and uncovertebral erosion
- pseudobasilar invagination
- canal stenosis possible d/t “stepladder” kyphotic changes
name them
a - typical SI joints
b - widening
c - sclerosing
d - ankylosing joints
what view is this?
lumbosacral spot view or L5-S1
what is this?
AS
- sclerosis at SI joint
what is noted on the left?
what is this
- ossification of outer annulus = thin, marginal sydesmophyte formation (bamboo spine)
- erosion (squaring of body)
- reactive sclerosis (shiny corner sign)
- late changes = ballooning of disc space
Ankylosing spondylosis
what is this?
AS
What is this sign?
squaring of the body is called?
what condition is this?
shiny corner sign
reactive sclerosis following inflammatory erosion
Romanus lesion
AS
what is this called?
what condition
dagger sign
AS
what is this called?
what condition
possibly trolley track
AS
what is this?
what is the treatment?
erosion > sclerosis > periosteal new bone (“whiskering”)
enthesopathy (iliac crest, ischial tuberosities, femoral troch, SPs, calcaneus)
AS in peripheral joint
Treatment: pain control, maint mobility, prevent deformity, anti-inflammatories
involvement of all 3 joints in a single digit is called what? what condition does this suggest?
ray pattern
psoriatic arthritis
typically happens at DIPs and PIPs
what is this?
opera glass hand
psoriatic arthritis
what is this?
erosion, new bone growth
psoriatic arthritis
what is the yellow cirlce showing?
what condition?
pencil-in-cup deformity
psoriatic arthritis/ reactive (hard to tell the 2 apart)
Observe asymmetric, non-marinal syndesmophytes
Q: What condition might this be?
Q: DDX?
Q: if they were symmetrical and marginal syndesmophytes, Dx?
psoriatic
DDX: reactive
Dx: AS
what is this condition?
enthesopathy noted
Condition: psoriatic/reactive
Photo: normal
what is this?
Reactive arthritis
- osteopenia
- erosions
- enthesopathy
what is noted on the left radiograph?
what are the arrows noting on the right?
1 - asymmetrical mid-body to mid-body syndesmophyte
2 - bi sclerotic changes
psoriatic/reactive (asymmetrical SI DDX)
30 yo F, positive ANA, fever, joint pain, rash.
what is it?
Systemic Lupus Erythematosus (SLE)
Joint manifestations:
- 80% patients
- Bilateral, symmetric
- Hand, knee, wrist, shoulder
- Pain, stiffness, swelling
- Transient, reversible deformities
- Soft tissue calcifications
- Osteoporosis (juxta-articular)
- Osteonecrosis (due to steroid use)
- No erosions
40 yo F, edema, induration, atrophy of skin.
what is this?
Scleroderma AKA systemic sclerosis
Generalized, systemic, inflammatory CT disease associated w/ CREST syndrome. Involves skin, lungs, GI tract, heart, kidneys, MSK system.
radiographic findings: acro-osteolysis (ungual tuft) and soft tissue calcifications
predominantly women, childbearing age. asymptomatic but sometimes chronic LBP and stiffness. SI motion may be altered.
what condition is this?
describe the findings
Osteitis Condensans Ilii (OCI)
radiographic findings:
- bi symmetric triangle-shaped areas of sclerosis on iliac side of lower SIJ
- complete regression may occur over years
- no joint abnormalities (NO widening, narrowing, erosion)
- similar process may affect medial clavicle
patient presents with severe pain that subsides over 1-2 years.
what is this?
what are the radiographic findings?
Osteitis Pubis
Radiographic findings:
- bilateral, symmetric invovlement of both sides of symphysis
- irregular joint margin
- reactive sclerosis
- widened joint space
following brochogenic carcinoma… what is this?
what is the associated triad?
Hypertrophic osteoarthropathy
Triad:
- digital clubbing
- symmetric arthritis
- periosteal reaction
what is the arrow on the distal tibia pointing to?
what is the arrow on the chest xray pointing to?
what condition is this?
periosteal response
bronchogenic carcinoma (likely)
hypertrophic osteoarthropathy
what is this?
MC in what pop?
what are the 5 stages of this disease
MC Locations?
Gout
Population: M:F >40yo
5 stages of Gout:
asymptomatic, acute, intercritical, chronic, gouty neuropathy
Locations: 1st MTP, hand + wrist, knee, elbow, SI, spine
what is this?
Calcium Pyrophosphate Dihydrate (CPPD)
Crystal Deposition Disease
Radiographic features
- chondrocalcinosis
- hyaline: parallel to cortex, thin, linear
- fibrous: thick, irregular, poorly defined
56 YO F. Chronic bi knee and shoulder pain
what is it?
how do you make a definitive Dx?
Calcium Pyrophosphate Dihydrate (CPPD)
Dx: aspiration of synovial fluid demonstrates crystals
what is this called?
what is the condition?
SLAC wrist
ScaphoLunate Advanced Collapse - MC degenerative arthritis of wrist. Hallmark is collapse on radial side of wrist.
Pyrophosphate arthropathy
what is this?
where is the MC location for this?
pyrophosphate arthropathy
photo shows SLAC wrist
MC Locations:
-
Knee:
- MC site for radiographic + clinic findings
- suspect w/ isolated patellofemoral or tricompartmental involvement
-
Wrist:
- arthropathy at radiocarpal joint
- scapholunate dissociation
- SLAC wrist (scapholunate advanced collapse)
what is this?
ddx?
chondrocalcinosis affecting menisci
Pyrophosphate arthropathy (can occur with or without chondrocalcinosis)
DDX: primary DJD
- unusual joint or joint compartment involvement
- prominent cysts
- severe changes
- variable osteophyte formation
what is this?
MC locations?
Hydroxyapatite Deposition Disease (HADD)
Locations: shoulder, hip
Radiographic:
- calcification near insertion of tendon
- linear or round / oval / globular
- usually homogenous, well-defined; less at early stages
- calcification may change or disappear over time
- US is more sensitive to early calcification
39 yo M presented in ED w/ 3-day Hx of throat pain and stiff neck. Radiographs were performed.
What is the condition?
Phases?
Hydroxyapetite Deposition Disease (HADD)
Phases: precalcific, calcific/formative, resorptive, post-calcific
