Hematologic and Vascular Disorders Flashcards
death of osseous cellular and marrow components of bone
avascular necrosis
synonyms for avascular necrosis
- osteonecrosis
- ischemic necrosis
- osteochondrosis
what makes epiphyseal necrosis clinically evident
articular surface collapse
etiology for AVN
spontaneous/idopathic MC others PLASTIC RAGS
what happens to marrow space pressure in AVN
increases
AVN is caused by obstruction of extra- and intra- osseous vessels by (4)
- arterial embolism
- venous thrombus
- traumatic disruption
- external compression
four stages of AVN
- avascular
- revascularization
- repair
- deformity
obliteration of epiphyseal blood supply precipitating death of osteocyte and bone marrow cells occur during this phase of AVN
avascular phase
growth is altered in which phase of AVN
avascular phase
in the avascular phase, epiphyseal and articular cartilage growth slows down or stops
FALSE; epiphyseal growth slows but articular cartilage growth continues
in which phase of AVN does deposition and resorption of bone occur
revascularization phase
during revascularization phase of AVN, deposition occurs and new bone is deposited directly on dead bone, thickening traveculation and increasing density… phenomenon known as
creeping substitution
resoprtion is secondary to ___, ___. ___ and produces bony fragmentation
phagocytosis, fibrosis, infiltration
(phase of AVN) bony resorption replaced by bony deposition
repair and remodeling phase
(phase of AVN) restitution of epiphysis to its normal configuration
deformity phase
residual deformity is due to
force exerted on necrotic bone during revascularization and repair phases
general radiological features of epiphyseal infarction (6)
- collapse of articular cortex
- fragmentation
- mottled trabecular pattern
- sclerosis
- subchondral cysts
- subchondral fracture
represents impaction fracture of necrotic bone, loss of normal smooth contour
collapse of articular cortex
manifestation of resorption and weakening, radiolucent clefts appear
fragmentation
reveals thickened irregular pattern traversing necrotic areas
mottled trabecular pattern
mottled trabecular pattern is most likely seen in which phases of AVN
- revascularization
- repair
occurs w revascularization of new bone, deposited around dead trabeculae. Typically occurs centrally, peripherally cortical margin or maybe a homogenous/patchy increase in density
sclerosis
patchy well circumscribed areas of rarefaction identical to DJD cysts
subchondral cysts
result from weakened subchondral bone, separates articular cortex from cancellous bone
subchondral fractures
subchondral fractures have which radiological signs associated with them
crescent/rim sign
metaphyseal and diaphyseal infarcts MC locations
distal femur, proximal tibia, proximal humerus. usually medullary
AVN of adult femoral head
chandler’s disease
who is more prone for chandler’s disease
4:1 males
necrotic area tends to be wedged or semilunar shaped, apex centrally, involving anterior superior margin
bite sign
bite sign most likely indicates which disease
chandler’s disease
subchondral bone collapse is indicated by which sign
crescent sign
AVN of humeral head is indicated by which sign
snow cap sign
healed AVN in femoral head is indicated by which sign
hanging rope sign
articular deformity leading to early DJD, acetabular dysplasia, along with trochanteric overgrowth is indicative of
healed femoral head AVN
AVN indiciated on MRI by loss of marrow signal on ___
T1
AVN of femoral capital epiphysis before closure (in children)
legg-calve-perthes disease
boys or girls more affected by legg-calve-perthes disease
boys 5:1
symptoms of legg-calve-perthes
- groin pain
- limping
- limitation of motion (abduction, internal rotation)
radiographic findings for legg-calve-perthes disease (7)
1) ST swelling
2) small epiphysis (fragmented)
3) lateral displacement of ossification center
4) flattening, fissuring and fx of ossification center
5) metaphyseal widening and foreshortened
6) widened irregular physis
7) intraepiphyseal gas
osteochondrosis dessicans of the tibia
osgood schlatter’s disease
osteochondrosis dessicans MC location
knee - medial femoral condyle
local, focal AVN
osteochondrosis dessicans
what is the fragmetation due to osteochondrosis dessicans called
joint mice
osteochondrosis dessicans normally ankle joint location
medial side of the talus
fragmentation of the apophysis of the tibial tuberosity
osgood schlatter’s disease
involvement of the inferior pole of the patellar
sindig-larsen-johanssen disease
fragmentation and flattening deformity, usually of the seconds MTP joint
freiberg’s disease
AVN of met heads, common in females, high heeled shoes
freiberg’s disease
AVN of lunate
kienbock’s disease
who is at risk for developing kienbock’s disease
individuals engaged in manual labor
disease associated with ulna minus variant or negative ulnar variance (short ulna)
keinbock’s disease
affects of kienbock’s disease
- initial lunate increased density
- later fragmentation and collapse
- sclerosis and radiolucency mixture
- flattening, collapse, and fragmentation
- altered jt congruity and biomechanics precipitates DJD
increased lunate density is an indication of
kienbock’s disease
a short ulna indication of
keinbock’s disease
patchy, homogenous sclerosis of navicular, collapse and fragmentation of tarsal/navicular
kohler’s disease
thoraco-lumbar scheuermann’s disease
juvenile discongenic disease
is severs disease a necrosis/AVN
no
sclerosis and fragmentation of calcaneal apophysis represents normal anatomy
severs disease (phenomenon, not really a disease)
serpiginous regions of calcification within the bone medulla that are usually associated with arteriosclerosis
calcified medullary infarct
Ddx for calcified medullary infarct
enchondroma or chondrosarcoma
MC hemolytic anemia
sickle cell anemia
pain and swelling in hands and feet (hands and feet syndrome)
sickle cell anemia sx
patients with sickle cell anemia have a predisposition to
salmonella osteomyelitis
radiological findings for sickle cell anemia (6)
1) marrow hyperplasia
2) coarse trabeculation
3) osteopenia
4) hair on end skull
5) H shaped vertebrae
6) AVN
hair on end skull indicative of
sickle cell anemia AND thalassemia*MC
osteonecrosis due to sickle cell anemia where central VB infarcts and causes improper growth
H shaped vertebrae
reynold’s phenomenon/H-shaped vertebra/lincoln log vertebrae/ indicative of
sickle cell anemia
what should be done when H shaped vertebrae are seen on a radiograph
blood test for sickle cell anemia
thalassemia aka
cooley’s anemia
group of genetic blood disorders with abnormal Hb in people particularly of mediterranean origin
thalassemia
Thalassemia radiographic findings
- hair on end skull
- rodent faces maxillary overgrowth
- honeycomb trabeculae
- E-flask deformity
- marrow hyperplasia
fatigue due to chronic anemia, splenomegaly, cardiomegaly, and gallstones is indicative of
thalassemia clinical presentation
4 Hematological Diseases
- Sickle Cell Anemia (MC)
- Thalassemia
- Hemophilia
- Leukemia
Radiographic findings of hemophelia (6)
- ST intra-articular swelling
- osteopenia
- radiodense effusion
- square femoral condyles
- epiphyseal overgrowth
- wide intercondylar notches
X chromosome linked bleeding disorder - female carrier, manifests in males - present with joint pain
hemophilia
Clinical presentation of fever, malaise, joint pain, easily bruised, spontaneous bleeding
leukemia
malignant proliferation of WBCs
leukemia
Radiological findings of leukemia
- lucent submetaphyseal bands
- growth arrest lines
- osteopenia
- periosteal rxns
- osteolytic destruction of long bone met/diaphysis
