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PART 2 > MSK > Flashcards

MSK Flashcards

1
Q

achondroplasia is and path

A

congenital disorder resulting in rhizomelic dwarfism

FGFR3 mutation on chromosome 4p16.3 which causes abnormal cartilage formation

gain of function mutation with activation of inhib signal. all bones formed by endochondral ossification affected. membranous (like skull) normal.

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2
Q

Achondroplasia imaging

A

Antenatal
- short femur
- trident hand
- frontal bossing
- depressed nasal bridge

Cranial
- large vault, small base
- frontal bossing
- depressed nasal
- narrow FM
- comm hydrocephalus

Spinal
- posterior vert scalloping
- pregressive decreased interpedicular distance
- gibbus; kyphosis with bullet vert
- short pedicle canal stenosis
- widening IVD

Chest
- anteiror flaring
- AP narrowing of ribs

Pelvis
- horizontal acetabular roof
- tombstone iliac wings
- trident acetabulum
- champagne pelvic inlet

Limbs
- metaphyseal flaring
- rhizomelic shortening

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3
Q

Nail patella syndrome is

A

a rare AD condition results from symmetrical mesodermal and ectodermal abnormalities.

underlying genetic defect caused by loss of function mutation on LMX1B chromosome 9

XR
- hypoplastic/absent patella
- hypoplasia radial head/capitellum
- bilateral posterior iliac horns
- flared iliac crests with protuberant anterior iliac spines

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4
Q

Cleidocranial dysostosis is and imaging

A

rare polyostotic skeletal dysplasia caused by a CBFA1 gene mutation in AD inherited or sporadic mutation pattern

incomplete ossification of midline structures, including the clavicle and pubic bones

Skull
- wormians
- widened sutures/fontanelles
- basilar invag
- supernumery teeth
- abnormal ear structures

Chest
- absent/hypoplastic clavicles
- supernumery ribs
- hemivert with spondylosis

Pelvis
- iliac hypoplasia
- absent/delayed ossification pubic bone

Limbs
- short/absent fibular/raidus
- coxa vara

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5
Q

Melorheostosis is and pathology

A

aka leri disease. uncommon mesenchymal dysplasia manifesting as regions of sclerosing bone with dripping wax appearance

can be mono or polyostotic. tends to be monomelic. predilection for long bones. tendency for sclerotome distribution

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6
Q

Melorheostosis imaging

A

Classic
- periosteal cortical thickening
- endosteal thickening
- thick undulating ridges of bone (candle wax)
- confined to sclerotome

Osteoma like

Myositis ossificans like

Osteopathia striata like

Mixed

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7
Q

Mixed sclerosing bone dysplasia has features of

A

Melorheostosis
Osteopathia striata
Osteopoikilosis

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8
Q

Duchenne muscular dystrophy is

A

the most common muscular dystrophy

characterised by progressive muscle weakness and fatty replacement

x linked recessive pattern. DMD gene, encodes for dystrophin, becomes non fucntioning (more severe than Beckers)

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9
Q

Duchenne muscular dystophy imaging

A

fatty muscle replacement
scoliosis
hypoinflated lungs
cardiomegaly
gracile bones

MR
early invovlemnt of gastroc

eventual glutes, add magnus, then psoas, iliacus, quads, rectus, biceps, peroneus, soleus

sparing of; sartorius, gracilis, semitend, semimemb, tib posterior

Upper limb;
trics, bics, teres major, RC
spares; deltoid

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10
Q

Olliers disease is

A

a non hered skeletal disorder characterised by multiple enchondromas

should stop growingwhen the patient does, otherwise concern for malignant trasnformation

typically short tubular bones of hands and feet

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11
Q

Maffuci syndrome is

A

a congenital non hered mesodermal dysplasia characterised by multiple enchondromas with soft tissue venous malformations and/or spindle cell haemangiomas

somatic mutations in IDH1 or IDH2

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12
Q

Metachondromatosis is

A

the rare combination of multiple enchondromoatosis and osteochondromatosis (olliers and diaphyseal ecclasia)

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13
Q

Osteogenesis imperfecta is and path

A

a hetergenous group of congenital non sex linked genetic disorders of collagen type 1 production

disturbance in the synthesis of type 1 collagen, predominant protein of the extracellular matrix in most tissues

COL1A1 and COL1A2. can be AD, AR or sporadic.

can be mild, perinatal lethal or progressive deforming

hjallmark feature is osteoporosis and fragile bones that fracture easily. also blue sclera, dental frag and hearing loss

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14
Q

Osteogenesis imperfecta imaging

A

Head/spine
- basilar invag
- wormian bones
- scoliosis
- compression fractures
- codfish vert
- platyspondyly

Chest
- pectas ex or carinatum
- accordion ribs

Pelvis
- protusion acetabuli
- coxa vara

General
- severe op
- gracile bones
- cortical thinning
- popcorn calrc at meta/epiphysis
- zebra stipe sign (cyclic bisphosphonate therarpy)
- pseudoarthroses

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15
Q

Gracile bones ddx

A

NF1
Immobilisation
Muscular dystrophy
JRA
OI
Marfans
Homocystinuria
Haemophilia

NIMROD
- NF1
- Immob
- MD
- RA
- OI
- Dysplasia (marfans, homocystinuria)
- also haemophilia i guess

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16
Q

Wormian bones ddx

A

PORKCHOPS

Pyknodyostosis

OI

Rickets

Kinky hair

Cleidocranial dysostosis

Hypothyroid/hypophosphate

Otopalatodigital syndrome

Primary acroosteolysis (Hajdu Cheney)/ progeria

Syndrome of a Downs

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17
Q

Osteopetrosis is and path

A

AKA albers schonberg disease or marble bone disease

uncommon hered disorder. results from defective osteoclasts and overgrowth of bones. bones become thick and sclerotic, but more brittle

can crowd the marrow, resulting in myelophthisic anaemia and EMH/splenomaegaly

Features depend on subtype
- infantile AR osteopetrosis
- Benign adult AD osteopetrosis

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18
Q

Osteopetrosis types and imaging

A

AUTOSOMAL DOMINANT
- less severe type
- benign/adult
imaging
- bone in a bone
- erlenmeyer flask
- sanwich vertebrae
- alternating radiolucent metaphyseal bands

AUTOSOMAL RECESSIVE
- more severe, presents earlier
Imaging
- bone in bone
- triangle mandible sign
- defective dentition
- paranasal sinuses poorly pnematosised
- hyperteolrism
- dense inner table, low attenuation diploic, dense inner table
- hair on end

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19
Q

Bone in bone ddx

A

Normal

Cortical splitting and new periostitis
- sickle cell
- thalassemia
- gaucher
- chronic OM
- scurvy

Caffey disease

Abnormal metab
- hypothyroid
- hypparathy
- pagets
- acromegaly
- osteopetrosis

Disordered growth
- heavy metal
- hyper vit d

Subcortical osteopenia
- leukaemia
- mets
- complex regional pain syndrome

Oxalosis
Iatrogenic
- grafts
- bisphosphonate

Bone healing

Mnemonic: GHOST DRAGON
Growth arrest
Heavy metal/hypoparathy/hypothy
Osteopetrosis
Sickle cell, scurvy, syphillis
Thalessemia, TB
Disease of caffey, hypervit D
Rickets, radiation
Acromegaly
Gauchers
Oxalosis
Normal

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20
Q

Erlenmeyer flask deformity causes

A

AP OF DR GHLN
- achondroplasia
- Pyle disease
- Osteopetrosis /osteochondromatosis
- Fibrous dysplasia
- Down syndrome
- RA/RIckets
- Gaucher
- Hypophosphataemia, haemoglobinopathies
- Leukamia, lead poisoning
- Niemann Pick disease

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21
Q

Hair on end sign causes

A

HI NEST

Hereditary spherocytosis
Iron def anemia
Neuroblastoma
Enzyome def
Sickle cell
Thalassemia major

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22
Q

Osteopoikilosis is and assoc

A

sclerosing bony dysplasia characterised by multiple benign enostoses

often found with osteopathia striata and melorheatosis

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23
Q

Arthrogryposis is and assoc

A

descriptor that denotes congenital non progressive joint contractures invovling two or more body regions

Syndromes
- pena shokeir
- multiple pterygium
- fowler
- freeman sheldon

Non syndrome
- CNS anomalies
- NM disorders

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24
Q

Achondrogenesis is

A

a rare and extreme group of skeletal dysplasias

affects both bone and cartilage development

Can be AR or AD depending on type. May involving mutations in SLC26A2 and COL2A1 depending on type, or may be unknown.

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25
Q

Achondrogenesis imaging

A

fetal bony structures unable to be identified

extreme micromelia

can sometimes have calvarium, leaving a floating head appearance

additional
- micrognathia
- macrocephaly
- frontal bossing
- flat face
- anteverted nares
- long philtrum
- narrow thorax
- lung hypoplasia
- polyhydramnios/hydrops

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26
Q

Jeune syndrome is

A

aka asphyxiating thoracic dysplasia

rare short limb skeletal dysplasia characterised by contricted long narrow thoracic cavity

can be complicated by pulmonary hypoplasia, renal failure from cystic renal disease and hepatic cirrhosis

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27
Q

Jeune syndrome imaging

A

Thoracic
- short narrow elongated chest shape
- high riding clavicles
- irregular costochondral junctions

Skeletal
- dysplastic acetabula
- trident acetabula
- short flared iliac bones
- ischial/pubic spurs
- acromelia
- polydactyl
- short broad phalanges

Abdominopelvic
- cystic renal disease
- cystic pancreatic disease
- hepatic dysfx

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28
Q

Chondrodysplasia punctata is

A

a heterogenous group of skeletal dysplasia. calcific stippling of catilage and periarticular soft tissues is a common features.

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29
Q

Ellis van crevald syndrome is

A

aka chonddroectodermal dysplasia. rare skeltal dysplasia. type of mesomelic limb shortening.

mutations in either EVC1 or EVC2 on chromosome 4p16. AR with variable expression

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30
Q

Congenital pseudoarthrosis of hte tibia is

A

abnormal bowing that can progress to segmental bone loss simulating the appearance of a joint

aetiology is unclear but assoc with NF1

imaging
- progressive bowing
- short segment resorption
- angulation at absent bone segement
- mimics appearance of joint

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31
Q

Trevor disease is

A

aka dysplasia epiphysealis hemimelica. rare non hered disease characterised by osteochondromas arising from the epiphyses.

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32
Q

Fibrodysplasia ossificans progressiva is

A

aka munchmyer aka myositis ossificans progressiva. rare inherited characterised by progressive fibrosis and ossification of hte muscles, tendons, fascia, aponeuroses and ligaments. disabling and fatal.

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33
Q

Intramedullary osteosclerosis is

A

a sclerosing dysplasia assoc with increased bone formation within the medullary cavity. dx of exclusion

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34
Q

Mastocytosis is

A

excessive accumulation of mast cells in one or more organs

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35
Q

Mastocytosis imaging

A

Skeletal
- lytic, sclerotic or mixed
- diffuse invovlement is common
- sclerosis of axial skeletan and proximal long bones usually

Abdominal
- PUD
- diffuse small bowel thickening
- omental and mesenteric thickening
- hepatosplenomegaly
- ascites
- lymphadenopathy

Pulmonary
- nodules

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36
Q

Diffuse bony sclerosis ddx

A

3MPROOF

Malig

Myelofibrosis

Mastocytosis

Sickle cell

Pagets/pyknodysotosis

Renal osteodystrophy

Osteopetrosis

Other; sclerotic dysplasia, hyperthy, hypoparathy

Fluorosis

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37
Q

Pyknodysostosis is

A

aka toulouse lautrec syndrome aka osteopetrosis acroosteolytica

rare autosomal recessive bone dysplasia

characterised by osteosclerosis and short stature

def in cathepsin K, 1q21

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38
Q

Pyknodysotosis imaging

A

hands
- short stubby fingers
- “distal acroosteolysis”
- delayed bone age

Cranial
- delay in suture closing
- wormian bones
- frontoparietal bossing
- nasal beaking

Other
- vert sclerosis
- increased lumb lordosis
- vert segmental anomalies
- hypoplastic clavicles

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39
Q

Monteggia fracture dislocation is

A

ulnar shaft fracture

radial head dislocation

GRIMUS:
Gal: Radial fracture, Inferior dislocation
Mon: Ulnar fracture, Superior dislocation

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40
Q

Galeazzi fracture dislocation is

A

distal radius fracture

DRUJ dislocation/disruption

GRIMUS:
Gal: Radial fracture, Inferior dislocation
Mon: Ulnar fracture, Superior dislocation

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41
Q

Essex Lopresti fracture dislocation

A

radial head fracture

dislocated DRUJ

rupture of the interosseous membrane

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42
Q

Osteochondral defect is and aetiology

A

a focal area of cartilage damage and injury of hte adjacent subchondral bone plate and subchondral cancellous bone

aetiology
- osteochondritis dissecans
- avn
- subchondral insuff fracture
- impaction fracture
- post surgical

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43
Q

Osteochondral defects locations and staging

A

femoral condyle
humeral head
talus
capitellum

staging
1. limited to cartialge, subchondral oedema

  1. cartilage with subchondral fracture, no detachement
  2. detached, non displaced (rim sign)
  3. displaced
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44
Q

Osteochondritis dissecans is

A

end result of aseptic separation of an osteochondral fracment. gradual fragmentation of the articular surgace and results in an osteochondral defect.

majority thought to be related to trauma/microtrauma

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45
Q

Stress fracture is

A

fracture occuring due to mismatch of bone strength and chronic mechanical stress

can be
- fatigue; abnormal stress, normal bone
- insufficicency; normal stress, abnormal bone

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46
Q

Stress fracture imaging

A

location
- pars
- lower limb incl; femoral neck, anterior tibia, medial mall, talus, naviular, MTs (necks/base), hallux sesamoid

XR
- grey cortex sign
- increasing sclerosis or cortical thickening
- periosteal reaction/elevation
- fracture line

bone scan hot

MR
- periosteal soft tissue oedema
- band like bone marrow oedema
- t1 hypointense fracture

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47
Q

Insufficiency fracture is and causes

A

normal stress abnormal bones

includes looser zones

causes
- OP ++
- hyperparathy, dm, osteomalacia
- pagets, osteopetrosis
- marfans, FD
- meds; glucocorticoids, chemo
- radiation therapy

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48
Q

Bisphosphanate related fracture criteria

A

located in femoral diaphysis

major ft
- no or minimal trauma
- mainly transverse/oblique
- lateral cortex, medial spike
- no or minimal comminution
- endosteal thickening

minor ft
- diaphyseal thickening
- bilaterally
- prodromal sx
- delayed healing

exclusion cr
- not spiral/comminuted
- nor neck or intertrochanteric
- no underlying bone process
- not periprosthetic

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49
Q

Looser zones are

A

wide transverse lucencies with sclerotic borders traversing partwqay through a bone, usually perpindicular to cortex.

assoc with rickets and osteomalacia

type of insuff fracture. highly suggestive with symmetric and in classic loc; axialla scapula, rib, post ulnar. rami. medial femoral neck.

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50
Q

morel lavelle lesions are

A

closed degloving injuries assoc with severe trauma presenting as a haemolympathic colleciton or mass

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51
Q

diffuse bony sclerosis causes

A

3 m,s proof

Malig
Myelofibrosis
Mastocytosis
Sickle cell
Pagets/pyknodysotosis
Renal osteodystrophy
Osteopetrosis
Other; sclerotic dysplasia, hyperthyroid, hypoparathyroid
Fluoresis

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52
Q

diffuse bone marrow infiltration causes

A

MLML

mets, myeloma
lymphoma
myelofibrosis, mastocytosis
leukaemia

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53
Q

Primary myelofibrosis is

A

myeloprolif neoplasm. replcaement of bone amrrow with collagenous connective tissue and progressive fibrosis

characterised by
- EMH
- splenomegaly
- anaemia
- variable change in no of granulocytes and platelets

chronic clonal stem cell disorder. considered a chronic BCR ABL1 negative myeloproliferative disorder

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54
Q

Primary myelofibrosis imaging

A

osteosclerosis; axial, ribs, proximal humerus and gemur
superscan

hepatosplenomegaly
splenic infacrts
portal hypertension

complications
- gout
- splenic stuff like rupture or infarct
- bleeding
- thromboembolism

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55
Q

Hip AVN classification

A

Ficat and Arlet classification

Stage 0
- xray normal
- mri normla
- clinical normal

Stage 1
- xray osteopaenia
- MRI oedema
- bone scan uptake
- clinical pain

Stage 2
- xray mixed osteopaenia/sclerosis/cysts. no subchondral lucency
- mri geographic defect
- bone scan uptake
- clinical pain and stiffness

Stage 3
- xray crescent sign and cortical collapse
- MRI same
- clinical pain and stiffness, rad to knee

Stage 4
- xray end stage with degenerative change
- mri same
- clincial limp

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56
Q

AVN/osteoneocrosis signs

A

Double line
- two serpentine lines
- inner bright, outer dark
- granulation and sclerosis

Rim sign
- high T2 line between two low signal lines
- fluid between sclerotic borders of an osteochrondral fragment

Crescent sign
- subchondral fracture in setting of osteonecrosis
- curvilinear lucent subchondral line
- if articular surface flattening, suggests impending articualr collapse

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57
Q

AVN/osteonecrosis causes

A

PLASTIC RAGS

Pancreatitis, pregnancy
Lupus
Alcohol
Steroids
Trauma
Idiopathic/infection
Caisson disease, collagen vascular disease
Radiation, RA
Amyloid
Gaucher
Sickle cell

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58
Q

Ahlback disease

A

medial femoral condylkar avn

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59
Q

Brailsford disease

A

radial head avn

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60
Q

Buchman disease

A

iliac crest avn

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61
Q

Burns disease

A

distal ulnar avn

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62
Q

Caffey disease

A

entire carpus or intercondular spines of tibia avn

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63
Q

Dias disease

A

trochlear of talus avn

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64
Q

Friebergs infraction

A

MT head avn

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65
Q

Friedrich disease

A

medial clavicle avn

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66
Q

Haas disease

A

humeral head avn

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67
Q

Iselin disease

A

base of 5th MT avn

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68
Q

Kienbock disease

A

lunate avn

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69
Q

Kohler disease

A

patella/navicular (children) avn

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70
Q

kummell disease

A

vertebral body avn

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71
Q

legg calve perthes disease

A

femoral head avn

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72
Q

Mauclaire disease

A

metacarpal head avn

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73
Q

Muelle weiss disease

A

navicular (adult) avn

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74
Q

Panner disease

A

capitellum humerus avn

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75
Q

Peiser disease

A

scaphoid acn

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76
Q

sever disease

A

calcaneal epiphysis avn

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77
Q

thiemann disease

A

base of phalanges avn

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78
Q

Bone infarct imaging and ddx

A

XR
- sheet like central lucency with shell like sclerosis and serpiginous border

MR
T1
- serpiginous low signal
- peripheral rim enhancement
- central signal marrow
T2
- acute; ill defined high signal
- double line sign
- central signal that of marrow
Gradient
- double line

DDX
- Enchondroma; chondroid matrix, central marrow signal absent

healing NOF
normal red marrow
marrow tumour

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79
Q

Klippel trenaunay weber is

A

a rare congenital disorder characterised by
- venous malformations
- cutaneous capillary malformations, and
- limb overgrowth

80
Q

primary bone lymphoma is

A

less common than secondary. <5% bone tumours. <1% NHL. Typically DLBCL.

81
Q

Osteomyelitis imaging

A

Specific types/findings:
- subperiosteal abscess
- brodies abscess
- pott puffy tumour
- sclerosing osteomyelitis of garre

General
XR
- swelling/loss of normal soft tissue planes
- joint effusion
- regional osteopaenia
- perisoteal reaction/thickening
- focal bony lysis or cortical loss
- endosteal scalloping
- loss of trabecular bone architecture
- eventual formation of sequestrum, involucrum and cloaca

MR
T1
- intermediate to low fluid centrally
- low marrow signal
- cortical destruction
T2
- bone marrow oedema
- high T2 fluid
C+
- post con enhancement of marrow, abscess margins, periosteum, etc
penumbra sign
- rim lining of abscess cavity representing vascularised granulation tissue. usually muscle signal t1 and enhancing.

ddx
- charcot
- mets
- primary neoplasm eg; eqings, osteosarc, lymphoma, mm
- lch

82
Q

Septic arthritis imaging

A

XR
- effusion
- juxta articular osteopaenia
- narrowing of joint space
- destruction of subchondral bone

US
- joint effusion
- can have debris
- perisynovial vascularity

MR
- T1 low in bone
- T2 subchondral/pericapsular oedema
- C+ synovial enhancement, pericapsular enhancement

83
Q

Leprosy is and imaging

A

chronic infectious disease caused by mycobacterium leprae. attacks skin and peripheral nerves. characteristic invovlement of hands and feet.

imaging
- similar to other conditions where sensory impairment is complicated by traumatic injury and infection e.g. charcots
- motor denervation; clawed fingers/toes
- bone absorption; decreased length and tapered end “licked candy stick”

84
Q

Polio is and imaging

A

rare disease from poliovirus infectioin

imaging
- atrophy of involved areas, including bone and muscle
- similar to other NM disorders
- neuroimaging; ALS like abnormalities in the ventral motor tracts in spine and/or motor cortex

85
Q

Madura foot or maduramycosis is

A

caused by fungal infection

extensive destructive/lytic changes
MR/US dot in a circle sign

86
Q

Rheumatoid arthritis is

A

a chronic autoimmune multisystem inflammatory disease that affects many organs

clinical
articular
- symmetric deforming polyarthropathy
- fingers and hands

extra articular

pulmonarry
- interstial lung disease
- pulmonary nodules
- caplan syndrome

CV
- pericarditis
- atherosclerosis

cutaenous
- rheumatoid nodules in pressue areas
- rheumatoid vasculitis

haem
- anaemia of chronic disease
- felty syndrome (RA, splenomeg, neutropaenia)

occular

87
Q

Rheumatoid arthritis path

A

unknown aetiology, probably multifactorial

genetic predisp; eg HLA DR B1
environmental trigger eg EBV

leads to autoimmune response directed against synovium and organs

activation and accumulation of CD4 T cells starts cascade
- activation of macrophages, synovial cells and production of cytokins. prolif synovial cells. increased prod of destructive enzymes
- activating b cell lymphocytes prod antibodies invluding RF. makes immune complexes which deposit in tissue
- directly activate endothelial vells, increases adhesion and accum of inflamm cells
- producing rankl, activates osteoclasts

leads to pannus formation; oedematous thickened hyperplastic synovium infiltrated with inflamm cells. gradually erode bare areas initial, followed by articular cartilage

Markers
- RF
- anti CCP, ACPA
- CRP/RSR

88
Q

Rheumatoid arthritis MSK imaging

A

General
- marginal erosions
- soft tissue swelling
- osteoporosis, juxta articular
- symmetric joint space narrowing

Hands
- PIP/MCP. ulnar styloid. triqutrum
- DIPS spared
- sublaxation; ulnar MCP dev. outonniere and swan neck
- hitchhiker thumb deformity
- carpal insdtab
- ankylosis
- scallop sign; ulnar aspect distal radius, predicts extensor tendon rupture (vaughn jackson syndrome)
- pencil in cup

Elbow
- effusion
- narrowing
- periarticular erosions
- cysts

Feet
- similar to hands, pred for PIP and MCT (4th and 5th)
- subtalar joint involvemt
- hammar toe deformity
- hallux valgus

Shoulder
- distal clav erosion
- marginal humeral head erosive
- high riding shoulder

Hip
- joint narrowing, concentric
- acetabular protrution

Knee
- effusion
- joint space narrowing
- no OA changes

Spine
- dens erosion
- atlantoaxial subluxation
- atlantoaxial impaction
- fact joint erosion/fusion
- osteoporosis and fractures

MR
- synovial hyperaemia
- synovial hyperplasia (rice bodies)
- subchondral cysts and erosions
- juxta art oedema
- effusions

89
Q

RA MSK DDX

A

OS
- PIP DIP
- JOSS
- soft tissue sqwlling; hebberend DIP bouchard PIP
- no erosions

EOA
- PIP DIP and CMC1
- central erosions

PSA
- IP predominant
- marginal erosions, classic pencil in cup
- OP not a feature

Reactive arhritis
- lower limb pred
- osteopaenia, OP, JSN, cysts, sublucation
- marginal erosions
- similar distribution

SLE
- JSN, sclerosis, osteophytes
- ulnar deviation without erosions

CPPS
- usually MCPJ
- chondrocalcinosis and no eorsions

Gout
- punched out erosions
- tophi

90
Q

Rice bodies aetiology and ddx

A

aetiology
- RA
- TB, infecvtion, JIA
- chrnoic synovitis
- chrnoic burisits

ddx
- synovial chrondromatosis

91
Q

Distal clav erosion ddx

A

Bilateral
- atraumatic from microtrauma
- HyperPTH
- RA
- scleroderma
- PSA
- pyknodysotosis
- progeria

Unilateral
- RA
- post trauma
- myeloma
- met
-OM

92
Q

Dens erosion ddx

A

RA
SLE

CPPD
Gout

OA

Infection

Hyper PTH

tumours

T21

93
Q

Vaughn jackson syndrome

A

extensor tendon rupture in context inflammatory arthropathy, usually RA

94
Q

ank spond is

A

a seronegative spondyloarthropathy. results in fusion of the SIJ and spine.

associ
- uveitis
- psoriasis
- IBD
- osteopaenia
- CV disease
- upper lobe interstitial lung disease
- aortitis
- secondary amyloidosis
- cauda equina

RF negative. HLA B27 implicated.

95
Q

ank spond imaging

A

SIJ
- sacroilitis

Spine
- romanus lesion (shiny corner)
- vertebral body squaring
- non infectious spondylyodiscitis (anderson lesion)
- bamboo spine
- dagger spine
- dural ectasia

Hips
- whiskering of ligaments, particularly ischial tuberosities
- bridgind of PS

Shoulders
- anterlateral humeral head erosion; hatchet deformity

Chst
- progressive fibrosis and bullous change at the apices
- cardiomegaly

96
Q

enteropathic arthritis is

A

chronic inflamm arthritis. seronegative. assoc with ibd.

peripheral joints, sacroiliac joints, spondylitis similar to ank spond

97
Q

juvenile idiopathic arthritis is and path

A

most common chronic arthritis of childhood and corresponds to a group of subtypes

still disease; systemic onset, intermittent spiking fevers. salmon rash. hepatosplenomegaly.

path
several subtypes
oligo JIA
- <4joints first 6mo
- 1-6yo
- medium and large

polyartciular
- >5 joitns
- 1-4, 7-10
- small and medium joints

systemic (still disease)
- systemic sx
- arthritis weeks or months after

98
Q

Juvenile idiopathic arthritis imaging

A

soft tisue swelling
osteopaenia
joint space narrowing
erosions
growth disturbances
sublaxation

cervical
- atlantoaxial sublux
- odontoid eorosions
- anklyosis

hepatosplenomegaly. pericardial and pleural effusions

knee; widedned intercodylar notch (like haemophilic andnTB)

can have synovial changes and rice bodies on MR

99
Q

Adult onset still disease

A

rare multisystem inflamm condition. initially thought a variant of paediatric stills.

triad of
- high fevers
- arthralgia
- salmon coloured rash

negative RF and ANA

100
Q

psoriatic arthritis is and path

A

seronegative spondyloarthropathy

inflamm arthritis assoc with psoriaisis

assoc
- obesity
- htn
- t2dm
- hyperlipiadmiaea

path
- 60% HLA B 27 p[ositive
- uveitis and conjunctivitis
- cardiac rhythmn disturbance
- urethritis, prostatitis, balanitis, cevicities, vaginitis

101
Q

psoriatic arthritis imaging

A

hallmark ios erosive change and bony prolif. predominantly distal distribution
hands feet, sij and spine. bigger joints less common.
can be symmetric poly or asymm oligo

  • enthesitis
  • marginal erosions
  • pencil in cup defomity
  • porlif; fuzzy appearance around joint
  • joint subluxation
  • periostitis
  • dactylitis; sausage digit
  • acroosteolysis
  • arthritis mutlians
  • ivory pahalnx
  • sacroilitis
102
Q

reactive arthritis is

A

sterile inflammatory monoarticular or oligoarticular arthritis. follows infection at different site, commonly enteric or urogenital. seronegative

clinical
- arthritis
- conjunctivitis
- urethritis

cant see cant bee sore knee

enteric
- yersinia, salmonella, shigella, campylobacter
sex
- chalmydia
other
- brucellosis

103
Q

reactive arthritis iamging

A

distal preferred knee>MTP>calcnaeus?>ankle>SIJ

enthesitis at achilles and plantar fascia insertions

bulky poaravertebral floating osteophyte

similar to psoriatic; erosions, enthesopathy, prolief, juxtaarticula osteopeorisi, uniform JSN, fusiform soft tissue swelling

104
Q

Scleroderma is and path

A

autoimmune ctd characterised by multisystem fibrosis and soft tissue calcification

widespread deposition of collagen and other extracellular matrix proteins. believed to occur as a result of an abnormal immune response. small vessels involved early, dense capillary network. perivascular fibrosis and gradual luminal stenosis

assoc
- crest
- other ctd; sle, polymyositis, dermatomyositis

esr, rf,ana

105
Q

Scleroderma MSK

A

bone
- acroostelysis
- periarticular osteopaenia
- JSN
- erosions
- CMC joint resorption and radial subluxation
- pencil in cup

soft tissue
- subcut and periarticular calcification
- flexion contractions
- atropgy at tips of fingers

other
- rib resorption, mandibule, radius and ulnar
- terminal phalanfeal sclerosis

106
Q

Felty syndrome is

A

RA
splenomegaly
neutropaenia

SANTA
- spoleno
- naeamia
- neutorpaneia
- thrombocytopaenia
- arthritis

107
Q

OA classification

A

primary
- absence of antecedent insult
- strong genetic component

secondayr
- abnormal mechanical force
- previous joint injur
= post trauma
= prior surgery
= CPPD
= inflamm arthritis
= haemochromatosis

108
Q

Ganglion cyst is and classification

A

non malignant cystic masses. occur in assoc with MSK structures. most common soft tissue mass of the hand and wrist.

path unclear. thought result from myxoid degeneration of CT assoc with joint capsules and tendon sheaths

classification
bone
- intraosseous
- periosteal
- soft tissue
joint
- intraarticular
- juxtaarticular
nerve
- intraneural

locations
- most common hand and wrist
- dorsum wrist 60%
- also volar, flexor sheath, DIPJ
other notable
- spinoglenoid notch ganglion
- acl ganglion
- ankle/foot

109
Q

Ganglion cyst imaging

A

US
hypo and well defined

MR
- uni or multilocular
- fluid signal
- adjacent to joint or tendon
- can be t1 variable but usually low
- T2 hjigh
- rim enhancement

110
Q

synovial cysts are

A

paraarticular fluid filled sacs or pouch like structures containing synovial fluid and lined by synovial membrane.

111
Q

Charcot joint is and path

A

aka neurpathic joint. progressive degen/destruction in patients with abnormal pain and proprioception

path
- inflamm response from minor injury
- results in osteolysis
- can be atrophic or hypertrophic

atrophic
- most common
- earlier
- acute
- reabsorption ends of bone
- joint destruction with resorp fragments
- absent ostesclerosis and osteophytes
- non wt bearing joints

hypertrophic
- sensory nerves affected
- slow progression
- destruction with periarticular debris
- presence of osteosclerosis and osteophytes
- absence of osteopeorosis, unless also infected

112
Q

Charcot joint aetiology

A

DM
Syringomyelia
neurosyphilis
spinal cord injury
alcohol
tumours compressing nerves
amyloid
pernicious anaemia
polio
leprosy
ms
steroids
charcot marie tooth

S mnemonic
- sugar
- syphillis
- steroid
- syringomyelia
- spinal cord injry
- spina bfida
- scleroderma
- scaly disease (leprosy)
- spirit (etoh)

113
Q

Charcot joint imaging

A

Xr/CT
- destrutive and disorganising
- centred on joints
- development/fragmentation/dissolution; subchondral osteopaenia, bone frag, joint malalignment
- coalesnece; subchondral sclerosis, periosteal bone formation, fusion of larger fragments
- reconstruction; remodelling with rounding of fragments and ankylosis

MR
T1
- joints swollen, decreased signal
- fat planes adjcent to ulcers low
C+
- inflammatory areas ehance with central necrotic non enhancement
STIR
- early; increased
- later; loss of cortical outline and cortical destruction

features suggesting infection
- sinus tract
- diffuse marrow abnor
- replcaement of soft tissue fat
- thick rim enhancemnt
- joint erosions
- ghost sign - poor def of the margins on the bone, blending with the surrounding ingflamm and phlegmon. becomes visible post con

6 D’s
- density
- destruction
- debris
- distension
- disorganisation
- dislocation

114
Q

Paget disease is and path

A

common chronic metabolic bone disorder characterised by excessive abnormal bone remodelling

classicaly expanded bone with coarse trabec. pelvis spine skull and prox long bones.

disease of osteoclasts. aetiology unknown. viral infection (paramyxovirus) and genitic suscep postulated

three stages
- early destructive (lytic, clast)
- intermediate (active/mixed, blastic and clastic)
- late (inactive, sclerotic/blastic)

115
Q

Pagets disease imaging

A

Skull
- osteoporosis circumscripta
- cotton wool
- diploic widending (inne and outer)
- tam o shanter

spine
- picture frame
- squaring vertrabe
- verticle trabec thickening

pelvis
- sclerosis of iliopectineal and ishipubic; pelvic brim sign and obliteration of kohlers teardrop
- acetab protrusion
- enlarged rami/ischium

Long bones
- blade of grass
- lateral curvature gfemur
- anterior curvature tibia

bone scan
- marked uptake all phases
- micky mouse; vert bodies and posterior elements
- lincoln; diffuse mandible forming a bearded appearance

116
Q

Pagets disease complications

A

osseous weakinging and fractures
oa
hearing loss
- sensi from compression
- cond from dixation
neural compression
osteosarc
gct in skull
high outpiout heart failure
hperPTH
EMH

117
Q

banana fracture

A

horizontal path fracture in pagets

118
Q

basilar invagination ddx

A

PF ROACH

pagets
fd
RA/rickets
OI
achondroplasia
Chiari 1 and 2, cleidocranial dysostosis
hyperpth

119
Q

ivory vert dd

A

LIMPH

lymphoma
infection
mets and myelosclerosis
pagets
haemangioma

120
Q

Rickets is and path

A

deficient mineralisation of the growth plate in paeds

abnormalities in ca po4 homeostasis disrupt endochondral ossification

calcipenic
- high pth
- low ca
- low po4

phosphopenic
- low pth
- normal ca
- low po4

calcipenic
- vit d def
- dietary ca def
- defective vit d metabolism
- hereditary vit d resistance

phosphopenic
- hereditary hypophos rickets
- tumour induced rickets
- fanconi

121
Q

Rickets imaging

A

growth plate widening
- fraying
- splaying
- cupping
- pseudofractures (looser zones)

concurrent osteomalacia
- limb bowing
- drawn in lower ribs (harrisons sulcus)
- rachitic rosary anterior ribs
- codfish vertebra

post treatment
- harris growth arrest lines

122
Q

Hyperparathyroidism is, assoc and causes

A

effects of excess pth. can be primary secondayr or tertiary

assoc
- men1 and 2a
- familial hypocalciuric hypercalcaemia
- hyperparathyroidism jaw tumour syndrome

primary
- parathyroid adenoma
- parathyroid hyperplasia
- parathyroid carcinoma
- parathyromatosis

secondary
- chrnoic hypocalcaemia with renal osteodystrophy most commonly (also vit d def, malnurtirtion) resulting in parathyroid hyerplasia

tertiary
- autonomous parathyroid adenoma caused by chronic overstimulation of hyerplastic glands in renal insufficiency

123
Q

Hyperparathyroidism imaging

A

subperiosteal bone resoprtion
- radial prox/mid phalanges 2/3rd
- medial tibia, femur, humerus
- lamina dura; floating tooth

subchrondral resorption
- lateral clavicles
- ps
- sacroiliac joints

subligamentous resorption
- ischial tub
- trochanters
- inferior surface calc and clavicle

intracortical resoption
- cigar shaped lucency in cortex

terminal tuft erosion

rugger jersy spine

osteopaenia

brown tumours

salt and pepper skull

chondrocalcinosis

124
Q

Renal osteodystrophy is and imaging

A

aka uraemic osteopathy. constellation of msk abnormalities in patients with crf due to concurrent
- osteomalacia/rickets
- secondary hyperparathyroidism
- aluminium tox (if on dialysis)

imaging
- osteopaenia
- salt and pepper skull
- demineralisation; subperiosteal, subligamentous, cortical or trabec
- bone sclerosis; diffuse, rugger jersey
- soft tissue calcification
- amyloid deposition periarticular
- insuff fractures
- looser zones
- brown tumours

125
Q

Gout is and path

A

crystal arthropathy due to deposition of monosodium urate cystals in and around joints

monosodium urate crystals in periarticular soft tissues. needle shaped and negatively biorefringent. needles are chemotactic and activate complement

primary risk factor is hyperuricaemia. two main mechanisms

undersecretion of uric acid
- ckd
- hypertension
- hyperpth
- alcohol
- drugs
- lead poisoning
- obesity

overproduction of uric acid
- myeloprolifer
- haemolysis
- exercise
- lesch nyhan syndrome

126
Q

calcium pyrophosphate dihydrate deposition disease is and path

A

cppd disease is cooccurence of arthritis with cppd deposition in articular cartilage

weakly positively birefringenet. rhmboid or rod shaped.

Causes:
Idiopathic
Hereditary
Secondary
- haemochromatosis
- hyperpth
- hypothyroid

127
Q

CPPD imaging

A

OA unusual distribution
- wrist joint (can get SLAC)
- MCPJ, hook like osteophytes
- patellogemoral
- shoulder
- elbow

chondrocalcinosis

128
Q

Transient osteoporosis of the hip is

A

self limiting clinical entitiy, idiopathic, synonym of subchrondral insuff fracture of the knee

present with hip pain, progressive over several weeks and spontaneous onset. do not go on to have avn. can have migratory change after; regional migratory osteoporosis

129
Q

Transient osteoporosis of the hip imaging

A

XR
- subchrondral cortical loss femoral head and neck
- profound osteopaenia
- joint effusion
- JS preserved

MR
- bone marrow oedema head and neck
- no osteonecrosis
- subchondral fractures in half of cases
- sparing of the medial femoral head

130
Q

Bone marrow oedema syndrome of the foot and ankle is

A

aka transient bone marrow oedema syndrome of the foot and ankle

self limited patchy bone marrow t2 hyperintensities of unknown aetiology

related to transient osteoporosis of the hip and regional migratory osteoporosis

most frequently involves the talus but can be any of them

131
Q

Regional migratory osteoporosis is

A

rare arthralgia affecting weight bearing joints of the lower limb

non traumatic pain, peaks at 2 months and resolves. subsequent pain in another joint 2-10 later.

132
Q

Complex regional pain syndrome is and path

A

aka sudeck atrophy. affects the extremities, wide clinical spetrum

two types
- type 1; no underlying single nerve lesion (reflex sympathetic dystrophy)
- type 2; underling nerve lesion identified

aetiology
- trauma (minor)
- surgery
- idiopathic/immobilisation
- cns disorders
- MI

133
Q

Complex regional pain syndrome imaging

A

hands and feet distal to injury

XR
- severe patchy osteopaenia, periarticular
- soft tissue swelling and eventually atrophy
- subperiosteal bone resoprtion
- preservation of joint space

MRI
- patchy bone marrow oedema
- soft tissue oedema and enhancement
- skin thickening
- joint effusion
- synovial hypertropgy
- muscle atrophy (late)

NM
- increased tracer all three phases
- diffusely increased juxtaarticular activity all joints affected hand or foot

134
Q

Hydroxyapatite deposition disease is and imaging

A

disease of uncertain aetiology where there are periarticular and intraarticular calcium deposits. usually tendons. shoulder most often.

imaging appearance varies based on stage; formative, resting, resoprtive. Formative and resting appear as round to ovoid calcification with well defined borders. resoprtive ill defined with comet tail.

135
Q

Thyroid acropachy is and imaging

A

unusual pres of thryoid disease, usually graves and assoc with orbitopathy

imaging
- hands and feet
- tubular bones
- bilateral and symmetrical
- prominent smooth flowing periosteal reaction with new bone formation
- soft tissue swelling

ddx
- hpoa
- pachydermoperiostosis
- chronic vascular insuff
- hypervita
- fluorosis

136
Q

Hypoparathyroidism imaging

A

MSK
- focal and generalised osteosclerosis
- dense metaphyseal bands
- skull vault thickening
- dish like chages
- subcut calcification

CNS
- intracranial calcs, bg
- cataract

137
Q

Osteoradionecrosis is path and imaging

A

severe delayed radiation induced injury, characterised by bone tissue necrosis and failure of healing

microvascular damange, usually large radiation dose and in mandible

imaging
mandible
- ill defined cortical destruction without sequestration

elsewhere
- osteopaenia
- disorganisation and coarsening
- cortical irreg
- heterogenous bone density

138
Q

Intraossoues haemangioma is, path and location

A

benign tumours of vascular channels arising in bone

thin walled blood vessels with lining of single non atypical endothelial cells. hamartomatous vascular tissue within endothelium surrounding bone trabeculae and permeating marrow. can contain fat, muscle, fibrous and thrombi

benign and slow growing but can be locally aggressive

vert, skull, facial bones
long bones meta/dia

139
Q

Unicameral bone cyst is, path and location

A

common benign non neoplastic lucent bony lesiosn., typically seen in childhood and asx. can present with path fracture. usually 1-2nd decade.

simple cyst lacking true lining with typical features.

usually remains adjacent ot eh growth plate and migrates away and it resolves

location
- proximal humerus most
- prox femur next
- other long bones
- can be; spine, pelvis, calcaneus, iliac wing

140
Q

Myositis ossificans is, path and imaging

A

most common form of heterotopic ossification, usually in large muscles.

typically young adults resulting from trauma. can be in paraplegics

path
- metaplasia intramusclar connective tissue resulting in extraossoues bone formation
- granualtion tissue with fibroblastic and osteoblastic diff and osteoid formation
- mineralised osteoid matric develops with immatuure lamellar bone
- immune bone progfresses into mature lamellar cortical and trabecular

xr
- soft tissue swelling
- progressive calcs by 2-6 weeks
- classic at 2 months
- then smaller

MR
T1 ill defined
T2
- high signal peripheral up to 8 weeks
- central heterogenous low signal
- can have fluid levels
C+ enhancement often

Late
T1
- central high, peripheral low
T2
- peripheral low, central intermediate to high
C+ none

ddx
parosteal
- calc in centre and cont to periphery
soft tissue sarcomas

141
Q

Juxtacortical chondroma is and imaging

A

aka periosteal chondroma. rare benign chondral tumours arising from the periosteum of tubular bones. typically humerus, femur and other extremity bones

XR
- saucerisation with sclerotic periosteal reaction
- matrix calc in 50%
- <3cm typically

MR
- abutting cortex, pressure erosion neighboouring bone
- lobulated
T1: low to muscle
T2: high with low foci of calc
C+ heteorgenous, peripheral predominant

ddx
- periosteal osteosarcoma; lobulated margins and high t2 absent
- non epiphyseal chondroblastoma; reactive marrow
- juxtacrotical chondrosarcoma; larger
- bizarre parosteal osteochondromatous prolif BPOP; nora lesions; phalangeal
- cortical desmoid
- tenosynovail GCT

142
Q

ENchondroma is and path

A

aka chondromas. common intramedulla cartilage neoplasms with benign features. share histo features with low grade chondrosarc

10-30yo. most common of the hand and wirst

assoc
- olliers
- maffuci

path
- lobules of mature hyaline cartilage
- partially or completely encased in normal bone
- arise from rests of growth plate cartialge which become isolated within mature bone
- no histo evidence of invasion

location
- small tube bones hands/feet
- large tube bones
- rare; pelvis, ribs, scap,l sternum

rarely may extend through cortex and demonstrate exophytic growth; enchondroma protubernas

143
Q

Enchondroma protubernas is

A

aka ecchondroma. rare form of enchondroma with growth pattern leading to deformity and remoddeling of the cotrex

144
Q

Olliers disease is

A

non hered sporadic skeletal disorder characterised by multiple enchondromas

145
Q

Metachondromatosis is

A

rare combinationof multiple enchondromas (Olliers) and osteochondromas (diaphyseal aclasia)

146
Q

Maffuci syndrome is

A

congenital non hered mesodermal dysplasia characterised by multiple enchondromas with soft tissue venous malformations and/or spindle cell haemangiomas

147
Q

Chondrosarcomas are and apth

A

malignant cartilaginous tumours. older patients and long bones. can be primary or arise froim existing chondroid neoplasm.

histo differs according to subtype. typically multilobulated with central high water and peripheral endochondral ossification

Subtypes
Primary
- convenital intramedullary; low, inter or high grade
- juxtacortical; l, i, h
- clear cell
- mycoid; i
- mesenchymal; h
- extraskeletal
- dediff

Secondary
- osteochondromas
- enchondromas

locations
- long bones
- pelvis
- ribs
- spine
- scapula
- sternum
- head and neck
- craniofacial

148
Q

Chondrosarcomas imaging

A

XR
- lytic
- intralesional matrix
- endosteal scalloping
- moth eaten/permeative
- cortical remodelling

CT
- matrix
- endo scalloping
- cortical breech
- soft tissue mass
- heterosgenous enahcnement

MR
- T1 low to inter
T2 high af
SWI blooming of mineralisation part
C+ heterogenous to intense

149
Q

Fibrous dysplasia is and path

A

developmental benign medulary fibroosseous process characterised by failure to form mature lamellar bone and arrest s woven bone

assoc
- mccune albright
- isolated endocrinopathy
- mazabraud syndrome

can be mono or poly ostotic

path
- altered osteogenesis leading to intramedullary fibroosseous prolief with fibrous and osseous componetsn presnet in various derees
- linked to GNAS mutation

Location
Mono
- ribs
- femur
- tibia
- craniofacial
- humerus

Poly
- unilateral/monomelic
- femur
- tibia
- pelvis
- foot
- ribs
- skull and fbs
- upper extremities
- lumbar spine
- calvicle
- cervcle spine

150
Q

Fibrous dysplasia imaging

A

TGeneral
- intramedullary, expansile
- well defined borders
- smooth cortical contour
- endosteal scalll

XR
- cystic, sclerotic or mixed
- smooth and homogenous
- endosteal scalloping and cortical thiining
- other; ground glass matric, no periosteal reaction, rind sign

MR
- not useful
- t1 intermediate to low htero
- t2 variable
- hetergenous enahncemnt

ddx
pagets
- diff demo

nf1
- usually vert column. ribbon ribs.

osteofibrous dysplasia
- usually tibia with anterior boweing, begins in cortex, young children

adamantinoma
- tibial

nof
ubc
gct
enchondroma
haemangioma

151
Q

mccune albright

A

endocrinopathy (precocious puberty)
polyostotic fibrous dusplsia
cage au lait spots

152
Q

mazabraud is

A

fibrous dysplasia
intramuscular myxomas

153
Q

Non ossifying fibroma is and path

A

benign osteoclastic giant cell rich bone tumours. metaphyseal. children and adolescents.

assoc
- nf1
- jaffe campannuci syndrome

path
- bnign spindle cell tumours
- osteoclast like giant cells
- can fill up with bone
- mutations in KRAS and FGFR1 genes
- spindle shaped cells in storiform pattern
- haemosiderin deposition, foamy macrophages

location
- metaphysis or long bones
- less common in flat pelvic bones and mandible; might represent a gct with regressive change

154
Q

Non ossifying firboma imaging

A

XR
- polycystic multiloculated lucent lesion
- eccentric in metaphysis
- thin sclerotic rim
- paralell to axis of bone
- migrate with age away from physis
- progressively sclerotic

MR
- depends on stage of develoepemnt
- initially high to inter t2 with peirpehral low
- becomes low on all

155
Q

Intraosseous lipoma is and path

A

rare benign lesions. wide age range. slight male.

aetiology unknown. almost excluysively medullary cavity, usually of long bones. mature adipoctes without admixed haematopoietic tissue or bony trabeculae

location
- calcaneus
- fgemur (intertrochanteric)
- tibia
- fibula
- upper limb
- skull and mandible
- spine and pelvis
- ribs

156
Q

Intraosseous lipoma imaging

A

XR
- benign appearing osteolytic with well defined margins
- central calcs; cockade sign

CT
- fat containing lesions
- can be homogenous, heterogenous with sclerosis and calcification/ossification

157
Q

Macrodystrophia lipomatosis is, path and imaging

A

rare form of localised giganticism. non hered. assoc with syndactyly, clinodactyly and polydactyly.

marked increase in all mesenchymal elements, dominanted by adipose tissue in a fine fibrous network

Imaging
XR
- splayed, lengthened and broaded phalanges with endosteal and periosteal bone deposition
- overlying soft tissues arre markedly overgrown
- focal fat may be seen

MR
- fibrous strands seen within
- cortical thickening
- osseous hypertrophy
- bony outgrowths
- neural thickening

DDX
- NF1
- Fibrolipomatous hamartoma of the median/ulnar nerve
- Vascular malformation; haemangioma (incl Maffuci), AVm, KTW
- chronic hyperaemia; JRA, haemophilia
- Hemihypertrophy/BWS
- Russell Silver Dwarfism

158
Q

Lipoma arborescens is and imaging

A

rare condition affecting synovial linings of the joints and bursa with frond like deposition of fatty tyissues

normal synovium replaced by hypertrophied villi demonstrating markeddeposition of mature lipocytes

Imaging
XR
- assoc effusion
- can see degen change
- cam see fatty lucencies in soft tissue lesion

CT
- low density intrarticular mass
- non enhancing

MR
- fat containing frond like synovial mass, follows fat on all sequences

DDX
- loose bodies
- synovial osteochondramosis
- intraarticular tenosynovial giant cell tumour (low on T2, non fat signal)
- synovial haemangioma (enhances, FF levels)
- synovitis (no fat signal)

159
Q

Osteomas are and imaging

A

benign bone tumours. unknown aetiology. common. composed of lamellar/cortical type bone

locations
- paransal sinuses
- skull vault
- mandibular
- nasal bone

when multiple consider Garnders

XR
- ivory, round, dense. mature may have central marrow
MR
- low on all

ddx
- exostosis
- cementoosseous dysplasia
- pagets
- sclerosing osteomyelitis of garre
- osteoblastoma
- ossifying fibroma
- osteosarc
- fd
- odontoma

160
Q

Osteoid osteomas are, path and imaging

A

benign bone forming tumours, typically in children and adolescents. characteristic lucent nidus and surrounding reaction. night pain relieved with nsaids

three parts concentric
- nidus, representing the neoplastic process
- fibrovascular rim
- surrounding reactive sclerosis

location
- long bones; femur and tibia
- phalanges
- vertebra, posterior elements

FOS gene rearrangement

XR
- solid periosteal reaction with cortical thickening
- can sometimes see nidues

CT
- lucent nidus within surrounding slcerotic reactive bone. central small scelrotic dot

NM
- double density, hotter spot within hot area

DDX
- osteomyelitis/brodies abscess
- osteoblastoma (bigger)
- stress fracture
- cortical desmoid
- osteochondroma
- osteosarcoma
- bone island
- localised cortical thickening
- intracrotical haemangioma

161
Q

Osteoblastoma is, path and imaging

A

rare bone forming tumours. may be locally aggressive. compared to osteoid osteoma, larger, more frequently axial

locally aggressively, histo similar to osteoid osteomas. scoliosis. minimal response to nsaids. bone and osteoid forming with a rim of osteoblasts and vascular

location
- spinal volumn, posterior elements
- meta/dia in long bones

FOS gene rearrangement

Imaging
typically larger than 1.5-2cm
XR
- predom lytic with rim of reactive scelrosis
- expansive
- can be bubbly
- can have int calc
- can have soft tissue component
- may be surrounding raction
- can have 2ndry ABC

MR
non spec
T1 hypo to iso
T2 iso to hypo
C+ avid

ddx
- osteoid osteoma (smaller)
- ABC
- GCT
- osteosarc

162
Q

Osteochondromas are and path

A

benign one tumours. low malignant potential.

develop during childhood and remain for life.

typically sporadic, or
- hereditary multiple exostoses (diaphyseal aclasis)
- trevor disease (dysplasia epiphysealis hemimelica

considered a chondroid neoplasm, primarily part of growth plate which separates and grows away from a nearby joint. medullary continuity. hyaline cartlage caps. malignant transformation in cartialge cap, unlike in single sporadic

lcaotions
- lower limb
- upper limb
- spine

163
Q

Osteochondroma features assoc with sarcomatous transformation

A

GLAD PAST

Growth after maturity
Lucency (new)
Add scinitigraphic activity
Destruction
Pain after puberty
and
Soft tissue mass
Thickened cap >1.5cm

164
Q

Hereditary multiple exostoses path

A

autosomal dominant inheritance. rare. can rarely be assoc with enchondromatosis, known as metachondromatosis.

EXT1, EXT2 or EXT 3 genes on 8q24, 11p11-13 and 19p respectively

165
Q

Trevor disease is

A

extremely rare non hered disease characterised by osteochondromas arising from the epiphyses.

classification:
Classic
- hemimelic, more than one bone in single lower extremityy

Localised
- single bone unilateral or bilateral

generalised
- invovling whole limb from pevlis to foot

166
Q

Primary synovial chondromatosis is and path

A

benign monoarticular disorder of unknown origin, cahracterised by synovial metaplasia and proliferation resulting in intraarticular cartilaginous loose bodies or similar size. can be ossified.

self limiting benign neoplastic process. proliferative chondroid nodules of the synovium. three phases
- initial; metaplastic formation of nodules
- transitional; detachement and loose bodies
- inactive; resolution of synovial proliferation, bodies may increase in size

167
Q

Primary synovial chondromatosis imaging

A

XR
- depends on degree of ossification
- most often multiple and unifrom in size

MR
depends on preponderance on synovial prolief, LB formation and extent of calcification
typically chondroid signal
T1 inter
T2 high
can otherwise by fully ossified

ddx
secondary chondromatosis
- older, degen, fewer and larger fragments

tenosynovial GCT
- more confluent masses
- diffuse low intensity

synovial haemangioma

lipoma arborescends

siderotic synovitis

tumeral calcification

periarticular melorheaostosis

168
Q

Secondary chondromatosis is and imaging

A

disorder that denotes intraarticular loose bodies secondary to joint pathology such as trauma OA infection or neuropathic osteoarthropathy

fragments of bone, cartilage, or mixed. can enlarge if nourished by synovium

imaging
- usually larger, fewer and variable in shape than primary
- evidence of nearby joint pathology

169
Q

Talonavicular coalition imaging

A

uncommon

mushroom sign (looks like a mushroom)

170
Q

Hereditary multiple exostoses is

A

aka diaphyseal aclasis. autosomal dominant, characterised by multiple osteochondromas

EXT1, 2 or 3 gene, chromosome 8q24, 11p11-13 and 19p respectively

171
Q

Osteosarcoma is and path

A

malignant bone forming tumours. second most common primary bone after MM. can be primary or secondary, with diff histo types.

Assoc
- pagets
- irradiation
- retinoblastoma
- rothmund thomson syndrome
- fibrous dysplasia
- mazabraud

location
Primary
- typically metadispahysis of long bones in appendicular
- other; fibula, innominate bone, mandible (gnathic), maxilla, vertebrae

Secondary
- much wider, mirroring combined incidence of their underlying conditions

Can be classified by relationship to bone:
- intramedullary/central 80%
- surface 10-15%
- intracortical (rare)
- extraskeletal (5%)

Classification
Primary
- intramedullary
= conventional
= low grade central
= telengiectatic
= small cell
- surface
= parosteal
= periosteal
= high grade surface
Secondary

Path
- bulky heterogenous tumours
- haemorrhage, fibrosis and xcystic
- bone formation characteristic
- poorly formed trabecular bone with cellular pleomorphism and mitoses
- ALP may be raised

172
Q

Conventional osteosarcoma imaging

A

XR
- medullary and cortical destruction
- wide zone of stransition
- permeative or moth eaten
- agg periosteal rxn
- soft tissue mass
- tumour matrix/ossification
- ossified mets

MR
- can cross epiphysis so look for that
- look for extent
T1
- soft tissue; intermediate
- ossified’; low
- peritumural oedema;’ intermediate
- scattered haemorrhage;’ varoiable
- solid bits enhance
T2
- soft tissue; high
- ossified; low
- peritumoural oedema

ddx
- infection
- mets
- ewings
- abc

173
Q

Parosteal ostesarcoma is and imaging

A

subtype of osteosarc. arises from outer layer periosteam. most common juxtacortical or surface osteosarc. can progress to high grade.

composed of dense osteoid compoonent attached to outer cortex over narrow zone. originates from outer fibrous layer of the periosteam. extensive bone matrix and minimal fibroblastic atypia

immunohistochem; reactive to MDM2, CDK4

Imaging
XR
- usually metaphysis
- most commonly posterior distal femur, then tib, then humerus
- large lobulated exophytic cauliflower like mass with central dense ossification
- string sign; thin radiolucent line separating tumour from cortex
- tumour stalk; grows within tumour, obliterates radiolucent line
- cortical thickening without periosteal reaction
- tumour extension into medullary cavity

MR
- low on T1 and T2
- high t2 suggests higher grade

174
Q

Periosteal osteosarcoma is and imaging

A

second most common surface osteosarc. arise from inner germinative layer of the perioosteum. higher grade than parosteal and lower than conventional. predominantly chondroid matrix

location
- diaphyseal
- femur and tibia
- arises from cortex, atttached at origin.
- intramedullary extension is rare

XR
- broad based surface soft tissue mass
- extrinsic erosion of thickened underlying cortex
- perpindicular periosteal reaction extending into soft tissue component
- rxn; sunburst or codmans

MR
- low on T1 and T2, may see bony spicules radiating from the surface lesion
- may be huper on T2 which represents its chondroid matrix
- reactive marrow seen, but marrow invasion is rare

difficult to diff from conventional. conventional invovle entire circumfrence of bone and show intramedullary extension

175
Q

Telengiectatic osteosarcoma is and imaging

A

uncommon variant of central osteasarcoma. characterised by empty or blood filled cystic spaces separated by septa comprising >90% of the lesion

Location
- metaphysis of long bones, with extension into epiphysis or diaphysis
- dist femur>tibia>humerus>prox femur
- rare; fibula, skull and ribs, pelvis

XR
- expansile lytic bone lesion at metaphysis
- geographic bony destruction with a wide zone of transition
- less osteoid matrix than conventional

CT
- low atten FF levels
- thick peripheral and nodular septal enhancement
- osteoid matrix mineralisation

MR
- fluid fluid levels
- soft tissue componenent
- often heterogenosu
- enhancement of septa with nodularitty and sofgty tissue component
- hamoeerhage

ddx
- ABC/GCT; no soft tissue component, narrower zone

176
Q

Extraskeletal osteosarcoma is and imaging

A

rare mesenchymal tumour in the retroperitoneum and soft tissue of extremities without any bone attachement

subtype of osteosarc. usually middle ages. radiation risk factor.

well defined lesion with haemorrhagic and necrotic areas. high grade spindle cell malignancy with osteoid and chondroid matrix. resembles MFH, osteoblastic osteosarc and chondroblastic osteosarc

location
- lower extremity
- upper extremity
- retroperiotneum
- trunk

Imaing
XR
- soft tissue density with variable calcification

CT
- tumour with pseudocapsule
- calcification
- extensive central mineralisation and lack of peripheral well defined ossification distinguishes it from myositis ossificatns
- heterogenous post contrast enhancement

MR
- well circumscibred heterogenous mass with hameotrhage and necrosis
- t1 iso
- t2 hyper

177
Q

Gnathic osteosarcoma is and imaging

A

subtype of osteosarc in th mandible, maxilla

can be osteoblastic, fibroblastic or chondroblastic

imaging
OPG
- garrington sign (thickening of the periodontal ligament/membrane space of invovlet teeth in the setting of gnatic osteosarc)

CT
- cortical invoement
- soft tissue extension
- intramedulalry bone extensio
- matrix calc

178
Q

Rhabdomyosarcoma is and assoc

A

malignant tumour with skeletal muscle cell morphology. most common soft tissue tumour in children. generally young patients, slight male.

assoc
- nf1
- bws
- li fraumeni
- dicer 1
- costello syndrome

path
- differentiate into tumour resembling skeletal muscle rather than arising from

three subtypes
- embronal (spindle/botyroid/anasplatic)
- alveolar
- pleormorphic

Location
- head and neck (orbit, oro/nasopharynx, sinuses)
- genitourinary (paratest, bladder)
- other (trunk, gi tract)

imaging
- non spec, indistinguishable from other sarcomas
- in extremities, embryonal can cause bowering (suggest slow growth)
- haemorrhage common in alveolar and pleomorphic, heterogenosus with necrosis
- embryonal more homogenesis

179
Q

Ewing sarcoma is and path

A

second most common primary bone tumour of childhood. typically children and adolescents.

path
- small round blue cell tumour
- regular sized primitive appearing cells.
- closely related to soft tissue tumours pnet, askin, neuroepithelioma (ewings fam)
- non random t(11,22)(q24:q12) chromosome rearrangement

location
- lower limbs
- pelvis
- upper limb
- spine and ribs
- skull and face

almost always metadiaphyseal or diaphyseal

180
Q

GCT of bone is and path

A

locally aggressive and rarely malignant bony neoplasm. end of long bones. occur when growth plates are closed, typically early adulthood.

assoc
- pagets
- gorlin goltz
- jaffe campannuci

path
- locally aggressive and rarely metastasising
- eccentrically at ends of long bones
- thorught to arise from metaphyseal side of growth plates
- neoplastic mononuclear stromal cells and non neoplastic osteoclast like giant cells
- over expression in RANK RANKL by neoplastic mononuclear stromal cells signallying pathway with resulting hyperproliferation of osteoclasts

micro
- non neoplasti giant cells with neoplastic mononuclear cells between
- mitoses, atypical sugg malig
- haemorrhage, naeurysm, foamy macorcphages and haemidesiden depositon
immunopheno; h3.3-g34w
gene; h3-3a(h3f3a)

location
- eccentric, end of long bone
- distal femur
- prox tibia
- distal radius
- prox humerus
- sacrum
- vert bodies
- can be hands, feet, innominate bones

181
Q

Tenosynovial gct is and path and imaging

A

aka gct of tenddon sheaths. fibrohistiocytic tumours. usually benign. arise from synovium of joitns, bursae or tendons. synovial diff. can be localised or diffuse.

previously known as PVNTS. PVNS/PVNTS no longer recommnded.

unknown aetiology. can be localised or diffuse, intra or extraarticular.

micro; varying mononuclear cells, multinucleated fiant cells, foamy macrophages, inflammatory cells, haemosiderin deposition and stromal collagenisation.

csf1 translocation

localised
- most common in the fingers
- then wrist, ankle, foot, knee
- can be extra or intra artic

diffuse
- monoarticular large joints. knee, hip
- then ankle, shoulder, elbow, facts, tmj

182
Q

Aneurysmal bone cysts are and path

A

expansile osteoclastic giant cell rich bony neoplasms. composed of numerous blood filled channels and cystic spaces

path
- muliloculated blood filled spaces of variable size separated by fibrous septa. surrounded by thin reactive bone formation. rich in multinucleated osteoclast like giant cells

location
- eccentric metaphysis long bones
- adjacent to unfused growth plates
- long bones
- spine and pelvis
- short bones hands and feet (more central)
- craniofgacial
- epiphysis, epiphysis equiv or apophysis (rare but important)

do not express h3.3pgly34trp unlike giant cell tumours

cytogenitc rearrangments of the usp6 gene

183
Q

Nodular fasciitis is and imaging

A

non neoplastic rapidly spreading soft tissue lesion in the deep subcut region or in the fascia

most commonly volar forearm, lower extre, chest and back

path poorly understoof; could be reactive in response to trauma, could be chromosomal abnorm sugg neoplastic

can be subcut, facial or intramuscular. benign prolief of fibroblasts and myofibroblasts. rapid growth, abundant spindle shaped cells and mitotic activity.

imaging
US
- one or more well defined iso to hypo nodules with mildly increased vascular flow

MR
- can be myxoid, cellular or fibrous
- this accounts for variable intensity

ddx
- dupuytrens disease
- extraabdominal desmoid
- neurofibroma
- fibrous histiocytoma
- soft tissue sarcoma
- early MO

184
Q

Chondromyxoid fibroma is and imaging

A

rare benign cartilaginous neoplasms.

typically younger adults but varies. progressive pain/swelling

variable chondroid, myxoid and fibrous tissue. pseudolobulated architecture.

located in metaphyseal regions of long bones. may extend to epiphyseal line. classic upper third of the tibia. can be small bones foot, distal fgemur, pevlis

imaging
XR
- lobulated or oval eccentric lytic lesion
- well defined sclerotic margin
- expansile
- parallel to bone
- geographic bone destriction
- no periosteal rexn
- presence of septations
- internal matrix
- perilesional scelrotisis

MR
- T1 low
- peripheral nodular enhancement, can be more diffuse
- t2 inter to high

ddx
- abc
- gct
- nof (younger)
- chondroblastoma (younger)

185
Q

Chondroblastoma is and imaging

A

benign chondrogentic bone neoplasms. epip[hysius or apophysis in young patients

well defined tumours of chondroblastic cells, islands of chondroid matric with sclerotic rim. usually eccentric position in epiphysis and apophysis of long bones

imaging
XR
- radiolucent
- internal fluffy calcs
- narrow transition
- bone mieralisation
- endosteal scalloping, cortical thinning, erosion
- expansile remodelling
- rarely cortical breaches with soft tissue
- can have periosteal rex
- can have effusion

MR
- lobular internal architecture
- thin sclerotic rim
- surrounding oedema
- cortical invovetn
- soft tissue oedema
- T1; inter
- T2; variable, heterogenous inter
- STIR; high
C+ heteorgenous moderate, with surrounding marrow/soft tissue enhancement

ddx
- clear cell chondrosarcoma
- osteomyelitis
- intraosseous ganglion
- giant cell tumour (closed physis)
- abc
- CMF
- EG

186
Q

Chordoma is and path

A

uncommon malignnt tumours of the axial sckeleton

arising from embyronic remannts of the primitive notochord, rathkes pouch to coccyx

locally aggressive, uncommon mets

path
- firm masses
- fluid and gelatinous substance, and necrotic areas
- physaliphorous cells
- three subtypes; conventional, chondroid, poorly/dediff
- genetics; tbxt duplication, pik3ca signallming mutation, lyst mutation, smarcb1 deletion

location
- sacrococcygeal
- sphenooccipital
- vertebral bone; cervical, lumbar, thoracic

187
Q

Chodroma imaging

A

CT
- centrally
- well circum
- destrictive lytivc
- expansile soft tissue mass
- irregular intratumral calc
- enhancing

MR
T1
- inter to low
- small foci haemorrhage
T2
- high
C+
- hetregenous, honeycbomb arreapnce
SWI; variable blooming
DWI; variable

DDX
clival
- chondrosarc
- plasmacytoma
- meningioma
- macroadeonoma
- ecchordosis physaliphora
- benign notochodral cell tumour

Vert
- chondrosarc
- giant cell
- spinal mets
- plasma cystoma
- lymphoma

188
Q

Aggressive fibromatosis is and path

A

type of msk fibromatosis. non met but neoplastic. like desmoids of the abdomen (extra abd desmoid).

assoc
- trauma
- preg
- oesotrogen
- gardners
- fap

path
- non encap, poorly circumscribed, infiltrative
- insidious and invasive
- looks like scar tissue, fibroblasts embeded in abundant collagenous matric with increased cells at the periphery

location; superficial or deep soft tissues, anywhere. head and neck most common

189
Q

MSK fibromatosis classification

A

Superficial
Adult
- palmar (dupuytrens)
- plantar (ledderhose)
- knuckle pads
Children
- calcifying aponeurotic fibroma
- lipofibromatosis
- infantile difitial fibroma
- inclusion body

Deep
Adults
- desmoid; intraadomina, abdominal wall, extraabdomainal (breast, aggressive)
Children
- fibromatosis colli
- myogirboma
- myofibromatosis

190
Q

Solitary fibrous tumour is and path

A

rare neoplasm of mesenchymal origin. can be anywhere, characteristically; dura, liver, orbit, pleura, spinal cord

used to be hamengiopericytoma

mass effect. can have hypoglycaemia (doege potter syndrome) from IGF2 secretion

location
- pleura most common
- solid organs
- abdominal cavity
- extremities/trunk
- head and neck incl orbit

multilobulated firm masses. can have fat, haemorrhage, nrcosis

collagenous matric with arrays of spindle cells. necrosis, cyts, mycoid, calc and haemorrhage., vasculaity, atrypica or malignancy. staghorn blood vessels.

genomic inversion 12q13 locus, fusion of nab2 and stat6 genes

immunohisto
- stat6
- cd34
- cd99
- bcl2
- vimentin
- cytokeratin, s100, p53

191
Q

cartilage interface sign

A

rotator cuff tear
increased through transmission shows interface of hyaline cartilage and cortex
creates a double line parallel under tear

192
Q

osteopetrosis aut recess key features

A

oraganomeagly
anaemia
infantile and lethal

193
Q

osteopetrosis aut recess key features

A

oraganomeagly
anaemia
infantile and lethalsa

194
Q

sagging peribursal fat

A

rotator cuff tear

195
Q

hawkins sign

A

talus dome subchondral lucency after talar neck fracture
indicates viability

196
Q

Dense transverse metaphyseal bands ddx

A

PRINCES

Poisoning (lead, mercury)
Rickets
Infection (TORCH) Idiopathic hypercalc
Normal variant, neoplastic (leukaemia, lymphoma)
Congenital syphillis
Endocrine (congen hypothyr)
Sick cell, scurvy

PART 2 (11 decks)

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