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Di Imaging 2 > Infections > Flashcards

Infections Flashcards

1
Q

What is cellulitis?

A

infection of skin, subcutaneous fat, or connective tissue such as tendons/ligaments/muscle

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2
Q

What is osteomyelitis?

A

Infection of bone

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3
Q

What is septic arthritis?

A

infection of joint (synovial tissue/articular surfaces)

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4
Q

What are the at risk groups for infections?

A
  1. Immunosuppressed
  2. Diabetes
  3. Post-surgical
  4. Vascular insufficiency
  5. Sickle cell anemia
  6. IV drug users
  7. When conditions are right
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5
Q

What joints are drug addicts usually prone to infection in?

A

“S” Joints - spine, sacroiliacs, symphysis pubis, sternoclavicular

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6
Q

What is the most common organism for infection?

A

Staph aureus (90%)

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7
Q

What are the modes of infection?

A
  1. Trauma/post surgical
  2. Urinary tract infection
  3. Pneumonia
  4. Skin infections
  5. Open wound or cellulitis
  6. Heel sticks in infants
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8
Q

What are the route of dissemination of infection?

A
  1. Hematogenous
  2. Direct extension
  3. Direct implantation
  4. Postoperative
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9
Q

What is the most common route of dissemination of infection?

A

Hematogenous

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10
Q

What is the infantile pattern of vascular anatomy?

A

metaphyseal and diaphysral vessels may penetrate the physics (septic arthritis and osteomyelitis)

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11
Q

What is the childhood pattern of vascular anatomy?

A

1 year to physis closure, metaphyseal blood flow is slow and turbulent, metaphyseal vessels do not penetrate physics, separate epiphysis blood supply (tends to spare epiphysis and joint)

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12
Q

What is the adult pattern of vascular anatomy?

A

metaphyseal vessel penetrate the vanishing physics, establishing communication with the subarticular bone end (osteomyelitis and septic arthritis)

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13
Q

What are the most common locations for infections?

A 
Knee
Hip
Ankle (distal tibia)
Shoulder
Spine
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14
Q

What are the two major categories for infections?

A

Suppurative (pus)

Non-suppurative (TB)

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15
Q

What is suppurative osteomyelitis?

A

Bone marrow infection by (pyogenic) non-tubular organism (anything but TB)

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16
Q

What is the most common suppurative organism of infection?

A

Staph. aureus

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17
Q

What are the clinical features of acute infection?

A

Edmea, lymphadenopathy, warm skin, cellulitis, joint pain

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18
Q

What are the 4 radiographic stages of infection?

A
  1. Latent/Hidden
  2. Early
  3. Middle
  4. Late
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19
Q

How long is the hidden/latent stage of infection?

A

1 to 10 days

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20
Q

How long is the early stage of infection?

A

10-21 days

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21
Q

How long is the middle stage of infection?

A

weeks

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22
Q

How long is the late stage of infection?

A

months

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23
Q

What radiographic features may be present during the early stage of infection

A

Soft tissue edema and osteopenia (micro holes). Edema displaces lucent fat planes and tends to obliterate soft tissue margins and become mass like

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24
Q

How long is the early stage of infection of spinal lesions?

A

3 weeks

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25
Q

What radiographic features may be present during the middle stage of infection?

A

Permeative or lytic moth-eaten destruction (may cross anatomical barriers), periosteal response, solid, codman’s triangle, laminated

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26
Q

What can the middle stage of infection look similar to?

A

Ewing sarcoma

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27
Q

What radiographic features may be present during the late stage of infection?

A 
Cortical destruction
Draining sinus
Involucrum - bony collar
Cloaca - big open sore
Sequestrum - piece of dead bone inside bone
Sclerosis
Debris
Loss of joint space - both sides
Ankylosis
Chronic incomplete resolution
Immune deficient
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28
Q

What is a sequestrum?

A

Chalky, white area representing isolated dead bone and cortical and medullar infarcts

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29
Q

What can a sequestrum of infection look similar to?

A

Osteoid osteoma

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30
Q

What difference would there be between osteoid osteoma and sequestrum of infection?

A

Pain would be worse at night with osteoid osteoma and there would be a fever with infection

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31
Q

What is an involucrum of infection?

A

“bony collar” - chronic periosteal response, pus lifts the periosteum and causes new bone formation, trying to wall off the infection

32
Q

What is the body’s attempt to wall things off during the late stages of infection?

A

Involucrum

33
Q

What is a cloaca?

A

Ulcerative channel from bone to outside

34
Q

What is Marjolin’s ulcer?

A

A rare complication of infection that is squamous cell carcinoma within the channel of cloaca

35
Q

What stage of infection is cloaca associated with?

A

Late stage

36
Q

What is a Brodie’s abscess formation?

A

Localized, aborted form of suppurative osteomyelitis

37
Q

What does a Brodie’s abscess formation look similar to?

A

Giant cell tumor

38
Q

What are the symptoms of a Brodie’s abscess formation?

A

Localized pain, worse at night relieved by aspirin

39
Q

What symptoms of a Brodie’s abscess formation mimic?

A

Osteoid osteoma

40
Q

What location is a Brodie’s abscess formation commonly found in?

A

Metaphyseal region, MC distal tibia (ankle)

41
Q

What does a Brodie’s abscess formation look like?

A

Oval, elliptical or serpiginous (worm like) radiolucency with heavy reactive sclerosis

42
Q

What are the differences between a tumor and infection?

A

Tumor respects growth plates and deflects fascial planes while infection has no respect for growth plate or joint spaces

43
Q

What are features of septic arthritis?

A

Joint effusion, juxtaarticular osteoporosis, erosions, joint space loss, lytic destruction that crosses joint space

44
Q

What is one sign of infection in the hip?

A

Increased teardrop distance

45
Q

What distance is important regarding teardrop distance?

A

Greater than 11 mm or 2 mm difference from the opposite joint

46
Q

What are the fat planes of the hip?

A

Gluteus medius, obturator internus and iliopsoas

47
Q

Until what age is the intervertebral disc is still vascular?

A

20 years of age

48
Q

How does infection spread in someone under age 20 if it is in the spine?

A

Infection starts in disc then spreads to adjacent bodies/endplates

49
Q

How does infection spread in adults if it is in the spine?

A

Starts in anterior vertebral endplates then does to the disc with vertebral collapse and soft tissue paraspinal mass

50
Q

What is the most common location for infection in the spine?

A

Lumbar spine

51
Q

What is the most common location for infection in the spine in IV drug users?

A

Sacroiliac joints

52
Q

How is infection in the spine spread?

A

Batson’s Venous Plexus

53
Q

What are early radiographic features of infection in the spine?

A

Rapid disc space loss and endplate destruction

54
Q

What are the limitations of plain films in regards to infection?

A

Not really a sensitive exam, must have significant loss in bone density before it is detected, other imaging studies are better for detection of early infection

55
Q

Why is bone scintigraphy better for infection detection?

A

Maybe positive within hours, gallium for RBC, Indium for WBCs, very sensitive, often followed by MRI for evaluation of soft tissue

56
Q

What are the advantages of CT in infection?

A

See findings earlier than plain films, good for hard to image areas (spine, pelvis, sternum), findings are more specific and suggestive of osteomyelitis (increase marrow density, demineralization, periosteal reaction)

57
Q

What is another name for non-suppurative osteomyelitis?

A

TB

58
Q

What is Pott’s Disease?

A

TB in the spine

59
Q

What is referred to as the king of disease?

A

TB

60
Q

What is the most common cause of infection related death worldwide?

A

TB

61
Q

What is the most common secondary form of TB?

A

Skeletal involvement of TB

62
Q

What is the most common location of TB in the spine?

A

Thoracolumbar junction

63
Q

Where does TB like to spread under in the spine?

A

ALL

64
Q

Where does TB infection typically start in the spine?

A

Anterior endplate region

65
Q

What is the earliest radiographic finding of TB in the spine?

A

Disc space narrowing

66
Q

What is a common result of TB in the spine?

A

Vertebral body collapse

67
Q

What does TB look like on MRI?

A

Decreased T1 and increased T2

68
Q

What percentage of TB skin tests are positive?

A

90-100%

69
Q

What percentage of chest films are positive for granulomas?

A

50%

70
Q

What are some clinical signs of TB?

A

Unexplained weight loss, fever, chills, night sweats, tenderness in the involved bones and joints

71
Q

What is Gibbous formation?

A

Acute kyphotic angular deformity in the spine in a patient with TB

72
Q

What is the Phemister’s Triad?

A

Tuberculosis septic arthritis - juxtarticular osteoporosis, marginal erosions (both sides of joint), slow joint space loss

73
Q

What are treatment options for TB?

A

Chemo, debridement, arthrodesis, surgical

74
Q

Which has a slower progression of joint destruction? Suppurative vs TB?

A

TB

75
Q

Which has a slower response to therapy? Suppurative or TB?

A

TB

Di Imaging 2 (3 decks)

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