Meeting 2 Learning objectives Flashcards
What is osteoperosis?
Metabolic disorder due to endocrine and nutritional disorders.
How much bone needs to be removed before osteoperosis can be seen on radiographs?
30-50% of all bone calcium must be lost.
When is regional osteoperosis seen?
Seen with immobilization from 6-8 weeks.
What is osteomalacia?
Excessive ammount of uncalcified osteoid in the adult.
Due to vitamin D deficiency and hypophosphatemia seen in kidney disease.
What is seen in patients with osteomalacia?
Bowing deformities
Transversely oriented incomplete radiolucencies known as pseudo fractures or looser’s zones.
What are loosers lines?
Seen in osteomalacia running perpendicular to the cortex occuring most commonly on the inner border of bone.
How do loosers lines look in osteomalacia vs hypophosphatemia?
Hypophosphatasia looks very similar however the transverse radiolucency will be on the outer corticy of the bone.
Osteomalacia is on the inner corticy.
Osteopenia Radiographic signs
Radiolucency of bones thinning of cortexes, intracortical tunneling, and prominence of primary trabeculation occurring most commonly in the cortical bone.
what is the pathomnemonic for osteopenia?
Increased bone resorption and decreased bone production.
Leaves the primary trabeculations viewable in the bone as the horizontal are loss!!
What serum phosphate concentration is considered hypophosphatasia?
<2.5 mg/dL
What are the acute causes of hypophosphatasia?
Alcoholism, burns, starvation
What are the chronic etiologies of hypophosphatemia?
Hyperparathyroidism
Chronic diahrrea
Long term diuretic use
What is primary hyperparathyroidism?
Tumor/growth to the thyroid
What is secondary hyperparathyroidism?
Seen in renal disease.
Low Vit D levels lead to low calcium output leading to bone resorption.
what is tertiary hyperparathyroidism?
Parathyroid is enlarged and does not respond to vit D.`
What X-ray signs will be seen in hyperparathyroidism?
Subperiosteal bone resiprtion primarily as brown tumors (round lytic lesions)
Will also have acral osteolysis of the distal aspects of the phalanges.
What is renal osteodystrophy?
Very similar to hypoparathyroidism seen in patients with renal failure in which hyperphosphatemia results in excessive bone resorption to release calcium.
Will have calcified soft tissue and vessels in addition to what is commonly seen in osteoperosis, hyperparathyroidism and osteomalacia.
When given a childs X-ray physis which two conditions should immediately come to mind?
Scurvey and Rickets
What is the cause of rickets?
Hpyophosphatemia and vitamin D deficiency seen in children.
What are the X-ray signs of rickets?
Occur at the growth plate with widening of the physis, decreased density at the zone of provisional calcification leading to fraying/paint brush appearance.
Widening/cupping of the metaphysis.
What are the etiologies of scurvy?
Deficiency in vitamin C intake decreasing collagen in periosteal blood vessels resulting in perostitis.
How will scurvy present at the metaphysis?
Line if increased density (white line of scurvy)
with a line of decreased density (scurvy line) and a small beaklike outgrowth of bone along the margins of the metaphysis.
Extensive periostitis entire length of bone.
Epiphysis appears as an outer shell of increased density surrounding a central lucency (Wimbergers sign)
What are the radiographic signs of acromegaly?
Heel pad thickness greater than 25 mm
Widened joint spaces
Thickened met shafts
Proximal phalangeal shafts are thinned
What is the etiology of osteogenesis imperfecta?
Insuficient osteoid production
What are the X-ray signs of osteogenesis imperfecta?
Difuse osteopenia with honeycomb appearance.
Flared “Erlenmyer Flask Appearance” at the metaphysis.
What is the etiology of pagets disease?
Excessive formation and remodeling of bone with unknown etiology. Usually asymptomatic in the foot in those over 40.
What collagen precursors will be increased with pagets disease?
Hydroxyproline and alkaline phosphate levels
What are the four X-ray stages of pagets disease?
Osteolytic phase: Starts subchondral and spreads to metaphysis and eventual diaphysis = “Blade of Grass/Flame shaped” radiolucent changes here. Saber shin deformities of the tibia causing anterior bowing.
Osteolysis and osteosclerosis: Lucent diaphysis with sclerotic metaphyseal and epiphyseal regions.
Sclerotic stage: Cortical thickening and bone enlargement.
Malignant degeneration
What are the X-ray findings of sickle cell anemia/thalasemias?
- Sickle Cell: epiphyseal, metaphyseal, diaphyseal infarcts (appear sclerotic)
- Fingers and toes can cause dactylitis (very similar to psoriatic sausage toes)
- Thalasemias can also cause Erlenmeyer flask deformities.
How will osteopetrosis appear on X-ray?
Bone within bone sclerosis with erlenmeyer flask formation and sclerotic bands across the bone.
What is melorheostosis?
Single limb hypertosis along the bones periphery extending the entire length,.
Will have a candle wax appearance one side of the cortex.
What will osteopoikilosis show on radiograph?
Small well homogenized spheres mimicking bone islands at the ends of long bones.
How will osteopathia striata
inherited and asymptomatic
Linear regular bands of increased density from the metaphysis to the diaphysis parallel to the shaft.
How will pyknodyostosis present?
Presents with shortened limbs with osteosclerosis and osteolysis in the distal phalanges.
Just like hyperparathyroidism and psoriasis leading to acral osteolysis in the phalanges as well.
a. Venous stasis periostitis
Most common cause here. With chronic venous stasis, they hurt, are chronic and often had normal indurated redness around the sore. A non-healing ulcer could represent either a transition to squamous cell or an indicator to underlying osteomyelitis.
b. Hypertrophic osteoarthropathy:
Thickening along the sides of the bone from periosteal new bone formation. The bones become enlarged and the joints become painful.
e. Tuberous sclerosis
A favorite of the boards, three primary pathologies: Seizures, mental retardation and hamartomas (primitive tumors). Usually asked in the dermatology as it notoriously causes subungual fibromas.
What is myositis ossificans circumscripta?
Most common form of myositis ossificans.
Presents as a soft tissue swelling that proceeds to an ill-defined calcific density followed by ossification.
How can you differntiate myositis ossificans from osteogenic sarcoma?
Must perform a biopsy
What is heterotropic ossification?
Bone appearing in soft tissue where it normally should not be present.
What is the major radiographic feature of hypoparathyroidism?
Brachymetaphalange “sHortened digit!”
What is primary hypoparathyroidism?
Resection of the Parathyorid
What is pseudo hypoparathyroidism?
Tissue isnt responding to PTH
What is pseudopseudo hypoparathyroidism?
Everything is normal biochemically.
What are the two things that can lead to dactylitis in children with sickle cell?
Infection or infarction
95% of the time it will be infarction.
Which two disorders will result in metastatic calcifications?
Renal osteodystrophy (High potasium levels)
Hypoparathyroidism.
What are the four big causes of acral osteolysis?
Hyperparathyroidism
Psoriatic arthritis
Hypertrophic Osteoarthropathy
Pyknodisostosis
