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[PBR] Pediatric Imaging > MSK > Flashcards

MSK Flashcards

1
Q

Epiphysis are initially ______

A

Cartilaginous, converting to bone with development of secondary ossification center

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2
Q

Primary physis is responsible for

A

Longitudinal growth of the bone

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3
Q

Secondary physis is responsible for

A

Spherical growth of epiphysis

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4
Q

What are the characteristics of pediatric bone as compared to adults

A

Less dense, more porous and have lower mineral content compared with adults

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5
Q

Due to pediatric bones characteristics, it can undergo a greater degree of deformation before breaking. Therefore, what fractures are common in pedia population

A

Greenstick (unicortical) and torus (buckle) fractures, as well as plastic deformation, complete fractures and physeal injuries

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6
Q

In newborn, bone marrow is entirely

A

Hematopoietic (red marrow)

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7
Q

Bone marrow transformation to fatty (yellow) marrow begins when

A

Within the first year of life and occurs in a predictable manner

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8
Q

In the body as a whole, marrow transformation begins where

A

In the periphery, first occurring in the phalanges of the fingers and toes and progressing centrally

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9
Q

Order of fatty marrow conversion of epiphysis, metaphysis and diaphysis

A

Epiphyses are first to convert, occurring within 6 months of radiologic appearance of secondary ossification center, continues within diaphysis, followed by metaphysis, with the proximal metaphysis the last to convert

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10
Q

On MR, the physis has a ______ appearance

A

Trilaminar appearance

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11
Q

The trilaminar appearance of physis in MRI consists of:

A

Zone of cartilage- active chondrocytes;
Zone of provisional calcification- cartilage matrix become calcified;
Primary spongiosa- where woven bone is formed

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12
Q

Fibrocartilaginous structure that surrounds the physeal cartilage, low signal on all sequences. This is tightly tethered to the physis and acts as a barrier to disease

A

Perichondrium

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13
Q

A thin low SI structure that parallels bone cortex and is loosely attached to the shaft and tightly attached to the perichondrium. Deep to this structure is a rich vascular network that helps to feed the growing metaphyses

A

Periosteum

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14
Q

This fracture occurs from longitudinal stress and results in bowing of the bones, with an intact periosteum

A

Plastic deformation

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15
Q

Plastic deformation are common in

A

Forearm, tibia, fibula

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16
Q

Fractures that results from axial loading on an extremity, occurring at the metaphysis or metadiaphysis. The cortex is compressed and bulges without extension of the fracture to the cortex

A

Buckle or torus fracture

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17
Q

Represent 50% of pediatric wrist fractures

A

Buckle fracture

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18
Q

Incomplete fractures resulting from perpendicular forces that break one cortex, the side opposite the site of stress

A

Greenstick fractures

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19
Q

Most vulnerable to injury during periods of active growth, such as during early adolescence

A

Cartilage

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20
Q

Weakest portion of the physeal cartilage

A

Zone of provisional calcification

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21
Q

Pathophysiology of chronic physeal trauma

A

Repetitive loading can alter metaphyseal perfusion and interfere with the mineralization of hypertrophied chondrocytes

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22
Q

In high intensity runners, chronic physeal injury are common in _____, while in baseball players its common in the ______ which is called little league shoulder and in the _______ in gymnasts (gymnast wrist)

A

Knees- runners
Proximal humerus- baseball players
Distal radiu- gymnast

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23
Q

Manifests radiographically as widening of the primary physis, with sclerosis at the margins of adjacent metaphysis

A

Chronic physeal trauma

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24
Q

A subset of physeal injuries (either sequela of trauma, infection or ischemia) can lead to cellular disruption and ischemia, giving rise to the development of abnormal osseous connection (bone bridge or bar) between epiphysis and metaphysis. These bone bars can result in limb length discrepancy, angular deformity, or altered joint mechanics

A

Physeal bars

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25
Q

The incidence of physeal bar formation is higher after injuries to the

A

Distal femur, proximal tibia and distal tibia

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26
Q

These areas contribute to the greatest proportion of limb growth, and therefore, bars in these regions have the biggest impact on limb length discrepancies

A

Distal femur and proximal tibia

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27
Q

Salter harris type: separation thru the physis, usually thru areas of hypertrophic and degenerating cartilage cell columns

A

1

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28
Q

Salter harris type: fracture thru a portion of the physis that extends thru the metaphyses

A

2

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29
Q

Salter harris type: fracture theu a portion of the physis that extends thru the epiphysis

A

3

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30
Q

Salter harris: fracture across the metaphysis, physis and epiphysis

A

4

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31
Q

Salter-harris type: crush injury to physis

A

5

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32
Q

Growth centers that serve as the attachment sites for tendons and have a physis at its bone interface

A

Apophyses

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33
Q

Apophyseal injuries due to repetitive submaximal stress on an apophysis is called ______ Which causes microavulsions at the chondro-osseous junction with resultant secondary inflammatory changes that attempt to repair the physis leading to overgrowth. Manifests radiographically as widenjng and irregulariy at the physis

A

Traction apophysitis

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34
Q

Little league elbow location of traction apophysitis, due to chronic valgus stress applied to the medial epicondylar apophysis causing medial elbow pain

A

Medial epicondyle of elbow

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35
Q

Location of traction apophysitis in Sinding-Larsen-Johansson syndrome, resulting from excessive force exerted by the patellar tendon on the lower pole of the patella. Causes anterior knee pain

A

Inferior patellar pole

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36
Q

Site of traction apophysitis in Osgood-Schlatter disease, pain at the anterior tibial tuberosity due to repetitive traction of the distal patellar tendon on the maturing anterior tibial tubercle

A

Tibial tuberosity

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37
Q

Location of traction apophysitis in Iselin disease; traction of peroneus brevis tendon on the base of the 5th metatarsal apophysis which presents with lateral foot pain

A

Base of the 5th metatarsal

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38
Q

Site of traction apophysitis in Sever disease; excessive traction of the Achilles tendon onto the calcaneal apophysis causing heal pain

A

Calcaneus

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39
Q

Acute apophyseal injuries are common in active adolescents due to

A

Inherent weakness of apophyseal cartilage

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40
Q

Most common site of pelvic avulsion injuries in adolescents

A

Ischial tuberosity: hamstrings

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41
Q

Iliac crest muscle/tendon attachment

A

Abdominal musculature

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42
Q

Muscle/tendon attachment of anterior superior iliac spine

A

Sartorius, tensor fasciae latae

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43
Q

Muscle/tendon attachment of anterior inferior iliac spine

A

Rectus femoris muscle

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44
Q

Muscle/tendon attachment of greater trochanter

A

Hip rotators

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45
Q

Muscle/tendon attachment of lesser trochanter

A

Iliopsoas muscle

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46
Q

Most common of all pediatric fractures. They may be sen in newborns as a result from birth trauma

A

Clavicle fractures

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47
Q

Vast majority of clavicle fractures occur in

A

Middle 1/3 of bone

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48
Q

In children less than 13 years of age, direct impact to shoulder may lead to a physeal fracture of the ______ clavicle, aka periosteal sleeve fracture

A

Lateral clavicle

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49
Q

Age of the appearance and physeal closure of CRITOE

A

Capitellum-1 and 14 years
Radial head- 3 and 16 years
Internal (medial) epicondyle- 5 and 15 years
Trochlea- 7 and 14 years
Olecranon- 9 and 14 years
External (lateral) epicondyle- 11 and 16 years

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50
Q

Humerus fractures peaks during adolescence secondary to increased sports participation and are most commonly what type of salter harris fracture

A

Type 2

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51
Q

In young children, elbow fractures are commonly _______, with a peak incidence if 5-7 years

A

Supracondylar fractures

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52
Q

Most common mechanism of elbow fractures

A

FOOSH injury and the hyperextension load

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53
Q

In the normal elbow, the anterior humeral line (line drawn along the anterior cortex of the distal humerus) should bisect the

A

Middle 3rd of capitellum

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54
Q

In the setting of supracondylar fracture, the capitellum is displaced _____ to the anterior humeral line

A

Posterior

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55
Q

Have the highest rate of complications among upper extremity fractures

A

Supracondylar fractures

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56
Q

Complications of supracondylar fractures

A

Neurovascular compromise, compartment syndrome, Volkmann ischemic contractures and cubitus varus

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57
Q

If the medial epicondyle is displaced greater than ____ mm, fractures require surgical fixation

A

5 mm

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58
Q

Majority of forearm fractures are located in the

A

Distal aspect of forearm

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59
Q

Fracture of the ulna and dislocation of the radial head

A

Monteggia fx

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60
Q

Radial fracture with disruption of the distal radioulnar joint

A

Galeazzi fx

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61
Q

In older children, the most common carpal bone fx is

A

Scaphoid fx

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62
Q

Scaphoid fx is important to be recognized due to risk of

A

Avascular necrosis

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63
Q

Physeal injury of the proximal femur in which the femoral metaphysis displaces anteriorly, superiorly and laterally with respect to the epiphysis

A

Slipped capital femoral epiphysis

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64
Q

Most sensitive radiographic projection as the slipped epiphysis moves posteriorly and to a lesser extent more medially

A

Frog leg lateral

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65
Q

Presents as widening and irregularity of the proximal physis, relative loss of height of the epiphysis on the AP projection, loss of anterior concavity of the femoral neck, the metaphyseal blanch sign, and metaphyseal cystic change in chronic cases

A

Slipped capital femoral epiphysis

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66
Q

It is sign that presents as crescent-shaped area of increased density at the proximal and medial femoral neck as a result of the projection of the posterior portion of the femoral head

A

Metaphyseal blanch sign

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67
Q

Line drawn along the superior margin of the femoral neck

A

Kline’s line

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68
Q

In normal hips, the Kline’s line will intersect the _____ aspect of the epiphysis. In SCFE, the epiphysis is displaced ______ and the Kline’s line does not intersect the epiphysis or intersect more ______ compared to the other side

A

Normal- lateral aspect

SCFE- displaced medially or intersects more laterally compared to the asymptomatic side

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69
Q

Treatment for moderate SCFE

A

In situ pinning

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70
Q

In more severe SCFE, treatment is

A

Open reduction with gentle manipulation of the head of the femur back into its normal anatomic location followed by screw fixation

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71
Q

Most common complications following SCFE are

A

Avascular necrosis and chondrolysis

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72
Q

Occurs when cartilage of the inferior pole of the patella is pulled off from the inferior patellar pole, often with a small avulsed osseous fracture

A

Patellar sleeve fractures

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73
Q

On radiographs, it may show a small bone fragment inferior to the lower pole of the patella, patella alta and a joint effusion

A

Patellar sleeve fracture

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74
Q

Seen in children 8-13 y.o and are usually sports-related injuries occuring especially during cycling or skiing

A

Tibial spine avulsion fractures or tibial eminence fractures

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75
Q

Cause of tibial spine avulsion fracture

A

Weakness of the incompletely ossified tibial eminence compared to the stronger anterior cruciate ligament

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76
Q

Most common seen in teenage boys and the injury usually involves active extension of the knee with vigorous contraction of the quadriceps muscles, typically in jumping sports

A

Tibial tubercle fractures

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77
Q

Treatment for fractures confined to the tibial tubercle only

A

Conservative management

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78
Q

Tibial tubercle Fractures that extend into the epiphysis are treated by

A

Surgical fixation

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79
Q

Can occur due to axial loading injuries sustained by young children jumping on trampolines or in similar environments such as bounce houses, generally with larger child/adult

A

Fractures of the proximal tibial metaphsis or “trampoline fractures”

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80
Q

Presents as nondisplaced and non angulated linear or buckle fracture of the proximal tibial metaphysis and can be quite subtle

A

Trampoline fractures

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81
Q

Nondisplaced oblique fracture of the distal tibia that typically presents in childreb between 1 and 4 years of age

A

Tibial “toddler’s fracture”

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82
Q

Nature of trauma is usually mild, such as twisting injury from tripping while walking or running or fall from a modest height. Most of the time no history of trauma can be elicited

A

Distal Tibial toddler fracture

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83
Q

Appears as a faint oblique line crossing the distal tibial shaft terminating medially

A

Distal tibial toddler fracture

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84
Q

Ogden tibial fx classification: fracture of distal aspect of the tibial tubercle near the patellar tendon insertion

A

1A

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85
Q

Ogden tibial fx classification: fragment is displaced anteriorly and proximally

A

1b

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86
Q

Ogden tibial fx classification: fracture extends thru the junction of the ossification of the proximal end of the tibia and tubercle

A

2a

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87
Q

Ogden tibial fx classification: tubercle fragment is comminuted

A

2B

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88
Q

Ogden tibial fx classification: fracture extends to the joint and is associated with discontinuity of the joint surface

A

3A

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89
Q

Ogden tibial fx classification: tubercle fragment is comminuted

A

3B

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90
Q

Second most common physeal injuries in children. Seen only in adolescents, generally between 10 and 16 years of age, when the physis closes in an aymmetric pattern

A

Distal tibial transitional fractures, triplane and Tillaux fractures

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91
Q

Distal tibial physeal closure pattern

A

Centrally and then proceeds in an anteromedial direction, then posteromedially and finally laterally, which predicts the specific injury pattern

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92
Q

Salter 4 fx and have sagittal, transverse and coronal components traversing the physis

A

Triplane fractures

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93
Q

Isolated fracture to the anterolateral portion of the distal tibial epiphysis, a salter 3 injury. Seen in teenagers nearing skeletal maturity, affecting the only remaining portion of the distal tibial physis

A

Tillaux fractures

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94
Q

AP radiographs demonstrate a vertical fracture line withjn the distal tibial epiphysus extending laterally. Lateral radiograph will show an avulsed fragment displaced anteriorly

A

Tillaux fx

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95
Q

Length of displacement of triplane and tillaux fx that would need surgical reduction

A

More than 2mm

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96
Q

Tibial stress fx usually involve what part

A

Proximal 3rd of the bone and more common posteriorly

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97
Q

More sensitive modality in detecting stress fx

A

MRI

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98
Q

These fx are uncommon in active young children however can be seen in adolescents with the so-called “female athlete triad”: osteoporosis, amenorrhea and eating disorders

A

Insufficiency fx

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99
Q

Important cause of foot pain in the young child

A

Metatarsal and tarsal bones injuries

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100
Q

Impaction injuries of the hindfoot in toddlers can cause

A

Nondisplaced or buckle type fx of talus or calcaneus

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101
Q

May occur in young children with forced plantar flexion of the foot, with compression of the cuboid and the 4th and 5th metatarsals

A

Nondisplaced cuboid fx

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102
Q

Bunk bed fracture, sustained when a child falls or jumps from a height (vertical loading with plantar flexion) and there is buckle injury of the proximal aspect of the metatarsal

A

First metatarsal fx

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103
Q

Caused by acute injury or repetitive microtrauma that leads to thinning of the articular cartilage, fragmentation of the subchondral bone, and occasionally, loose bodies

A

Osteochondral lesions

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104
Q

Most common locations for osteochondral lesions

A

Weight bearing regions of the femoral condyle, capitellum of elbow in throwing athlete and gymnasts, and the ankle

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105
Q

“Bone-cartilage conditions” common in young children and comprise a heterogeneous group of injuries to the epiphyses, physis and apophyses

A

Osteochondroses

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106
Q

Result from a disturbance in endochondral ossification and are typically self-limited. Rapid growth, genetics, anatomic considerations, trauma, diet and a defect in vascular supply are proposed etiologies

A

Osteochondroses

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107
Q

Osteochondroses follow a unique series of events, which are:

A

Necrosis of bone, revascularization, reorganization, with granulation tissue formation and invasion, osteoclast resorption of necrotic segments and ultimately osteoid replacement with mature lamellar bone formed

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108
Q

Common location of osteochondral lesions in the knee

A

Lateral aspect of medial femoral condyle, weight-bearing surface of medial or lateral femoral condyle, patella, trochlea

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109
Q

Common OCL in the elbow

A

Capitellum, lateral aspect of trochlea

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110
Q

Common location of OCL in ankle/foot

A

Medial aspect of talus, lateral aspect of talus, central talar dome, distal tibia, subtalar facet, talar head

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111
Q

Osteochondrosis of the femoral head and is common cause of hip pain and limp in preadolescent children

A

Legg-Calve’-Perthes disease

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112
Q

Peak age and sex predilection of legg-calve-perthes disease

A

5-6 years, more common in boys

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113
Q

Most cases of legg-calve-perthes are unilateral or bilateral?

A

Unilateral

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114
Q

Early in its course of disease, radiographs may demonstrate widening of the medial joint space and asymmetrically smaller femoral epiphysis of the affected side with sclerosis. Physis may become indistinct, lucency may be seen within the femoral metaphysis, overtime the epiphysis may begin to fragment and flatten. Coxa magna of the femoral neck develops

A

Legg-calve- perthes disease

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115
Q

Prognostic indicators in legg-calve-perthes disease

A

Extent of osteonecrosis, amount of lateral extrusion, physeal involvement and metaphyseal abnormalities

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116
Q

Radiographic findings indicative of subsequent growth disturbance in legg-calve-perthes disease

A

Physeal abnormalities and metaphyseal lucencies

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117
Q

True or false: the younger the age of presentation in legg-calve-perthes disease, the more benign the course

A

True

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118
Q

asymmetrical, circumferential enlargement and deformation of the femoral head and neck.

A

Coxa magna of femoral neck

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119
Q

Self limiting osteochondrosis of the developing capitellum that affects children younger than 12 years. Most commonly seen in baseball pitches and falls into the spectrum of “little leaguers elbow”

A

Panner disease

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120
Q

Presumed cause of panner disease

A

Repetitive chronic impaction injury to the tenuous blood supply of the capitellum

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121
Q

True or false: the entire capitellum is usually involved in panner disease

A

True

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122
Q

Radiographically, it appears as demineralization of the capitellum with loss of the normally sharp cortical margins, followed by sclerosis and loss of volume and ultimately progressing to frank fragmentation

A

Panner disease

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123
Q

True or false: the overlying articular cartilage of capitellum is not affected in panner disease

A

True

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124
Q

Osteochondrosis of the tarsal navicular bone which occurs between 4 and 9 years of age with a higher prevalence in boys

A

Kohler disease

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125
Q

Sclerosis and narrowing/flattening of the tarsal navicular bone

A

Kohler disease

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126
Q

Osteochondrosis of the metatarsal head

A

Freiberg’s infarction

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127
Q

Freiberg’s infarction commonly affects the

A

Second metatarsal head, followed by the 3rd metatarsal head

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128
Q

On radiographs, it appears as widening of the metatarsophalangeal joint with collapse and sclerosis of the metatarsal head. This may be associated with loose body formation, dorsal spurring and consequent thickening of the metatarsal shaft

A

Freiberg’s infarction

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129
Q

Non accidental trauma such as skull fractures, rib fractures and displaced metaphyseal injuries predominate at what age

A

Infancy

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130
Q

Long bone injuries from non accidental trauma predominate at what age

A

After 1 year of age

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131
Q

Fractures with high specificity for abuse include

A

Classic metaphyseal lesions, rib fractures (especially posterior), scapular fractures, spinous process fx, and sternal fractures

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132
Q

Aka corner fractures or bucket handle fractures

A

Classic metaphyseal lesion

Salter-Harris II

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133
Q

Most frequently encountered long bone injury in abused children and are commonly seen in what bones

A

Distal femora, proximal and distal tibia and proximal humeri

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134
Q

True or false: CMLs may heal without significant callus or subperiosteal new bone formation which makes dating assessment difficult

A

True

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135
Q

When should follow up skeletal surveys be done in non accidental trauma patients as this will increase the sensitivity of depicting subtle or occult fractures

A

2 weeks after

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136
Q

3 major pathways of bone infection

A

Hematogeneous, direct inoculation and via extension from adjacent soft tissue infections

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137
Q

In children, acute osteomyelitis is most commonly acquired _______

A

Hematogeneously

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138
Q

Most common organisms involved in osteomyelitis in children

A

Staphylococcus aureus, B-hemolytic streptococcus and streptococcus pneumoniae, E.coli and pseudomonas aeruginosa

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139
Q

Acute hematogeneous osteomyelitis primarily involves the

A

Metaphyses of long bones or metapgyseal equivalents (osseous regions adjacent to a physis)

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140
Q

Metaphyses of long bones are common site for acute hematogeneous osteomyelitis due to

A

Presence of slow-flowing venous sinusoids

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141
Q

Complications of acute osteomyelitis

A

Subperiosteal abscess and ultimately dissecting into the adjacent soft tissues, thrombophlebitis, septic emboli, growth arrest due to bone bar formation, pathologic fx and chronic osteomyelitis

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142
Q

Most cases of epiphyseal osteomyelitis or chondritis occur in children of what age

A

Younger than 4 years

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143
Q

Epiphyseal osteomyelitis or chondritis are best demonstrated as

A

Avascular/non enhancing regions of affected cartilage

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144
Q

Thrombophlebitis as a complication of acute osteomyelitis is typically associated with

A

Methicillin resistant S. Aureus

145
Q

Caused by hematogeneous bacterial seeding or by direct extension into the joint space in the setting of osteomyelitis or adjacent soft tissue infection

A

Septic arthritis

146
Q

In very young infant, septic arthritis present as multifocal involvement, with the ____ as the most frequent site

A

Hip

147
Q

True or false: imaging cannot reliably differentiate a reactive effusion (toxic synovitis) from septic arthritis

A

True

148
Q

A self-limited disease with no known long term sequela. It is a common entity, particularly involving the hip in young children between 3 and 10 years of age. Children appear nontoxic and present with pain and limp and are usually afebrile with normal to marginally elevated WBC and inflammatory markers. Parents often report a preceding viral or bacterial upper respiratory or GI illness (within 4-5 weeks)

A

Toxic synovitis or transient/reactive synovitis

149
Q

Treatment for toxic synovitis or transient/reactive synovitis

A

Rest and analgesics and symptoms begin to resolve within 24-48 hours

150
Q

Very common benign tumor/tumor like lesion of bone and occur in approximately 1-2% of population. Thought to represent a developmental defect of bone growth secondary to an injury to the perichondrium, rather than a true tumor

A

Osteochondroma

151
Q

Condition in which physeal cartilage herniates through this defect and growth results in an osseous excrescence with continuity to the underlying medullary canal and cortex, with an overlying cartilagenous cap

A

Osteochondroma

152
Q

Most commonly affected part in osteochondroma

A

Lower extremity, commonly in the knee

153
Q

Radiographic hallmark of an osteochondroma

A

Osseous excrescence with continuity of the cortex and medullary space from the underlying bone into the osteochondroma

154
Q

When the osteochondroma is pedunculated, the lesion usually points where

A

Away from the nearest joint

155
Q

If the cartilageneous cap of osteochondroma is ____ cm in thickness, the very rare transformation to chondrosarcoma should be considered

A

More than 1.5 cm

156
Q

Multiple osteochondromas are seen in patients with

A

Hereditary multiple exostoses or familial osteochondromatosis or diaphyseal aclasis

157
Q

A distinct disorder secondary to osteochondroma development from an epiphysis that predominantly affects the lower extremities

A

Trevor disease or dysplasia epiphysealis hemimelica

158
Q

Uncommon benign cartilaginous neoplasms that characteristically arise eccentrically in the epiphyses or apophyses of children, with 70% occurring in the humerus, femur and tibia

A

Chondroblastoma

159
Q

Well-defined lucent lesions with smooth or lobulated borders and a thin sclerotic rim with perhaps endosteal scalloping

A

Chondroblastoma

160
Q

Treatment of chondroblastoma

A

Curettage and packing of the lesion or radiofrequency ablation

161
Q

Disorder resulting from the proliferation and accumulation of the Langerhans cell, a histiocyte. Cause is unknown altho some studies suggest abnormal immune regulation as the underlying factor and others consider it a neoplastic process

A

Langerhans cell histiocytosis

162
Q

Localized form of LCH usually presents in children age

A

10 to 12 y.o

163
Q

LCH can involve any bone, however there is a predilection for

A

Flat bones and more than half of the lesions in localized LCH occur in the skull, mandible, pelvis and ribs

164
Q

When there is long bone involvement, LCH usually occurs within the _____ with the ______ being the most common long bone site

A

Diaphsysis and femur

165
Q

Mandibular involvement in this condition may lead to floating tooth appearance due to the destruction of alveolar bone

A

Langerhans cell histiocytosis

166
Q

Management of langerhans cell histiocytosis

A

Curettage, ablative techniques and direct intralesional methylprednisolone injection, disseminated disease may be treated with steroids and chemotheraphy

167
Q

Most common malignant primary tumor in children and young adults

A

Osteosarcoma

168
Q

Gender predominance and age of peak incidence of osteosarcoma

A

Male, 15-25 years of age

169
Q

Types of osteosarcoma

A

Intramedullary, surface, extraskeletal and secondary osteosarcoma

170
Q

Most common type of osteosarcoma and is referred to as conventional osteosarcoma

A

High-grade intramedullary type

171
Q

These osteosarcomas arise from the medullary cavity of the metaphysis of long bones, most commonly in the distal femur and proximal tibia

A

High grade intramedullary osteosarcoma

172
Q

Typically appears as a mass that contains fluffy, cloudlike opacity which represents osteoid matrix production. Lesions usually have a mixed lytic and sclerotic appearance with cortical erosion and destruction. Given the aggressive growth pattern, there is often spiculated (sunburst) periosteal new bone and periosteal elevation is frequently seen resulting in Codman triangles

A

Osteosarcoma

173
Q

Skull lesions appear as beveled edge or “hole in hole” appearance due to unequal involvement of the inner and outer tables of the calvarium

A

Langerhans cell histiocytosis or eosinophilic granulomatosis

174
Q

An uncommon subtype of intramedullary osteosarcoma and is often confused with aneurysmal bone cysts

A

Telangiectatic osteosarcoma

175
Q

Type of osteosarcoma that tends to occur around the knee and contains large cystic cavities filled with blood or necrotic tumor, and the walls/septations contrain malignant cells that produce osteoid

A

Telangiectatic osteosarcoma

176
Q

Most common surface osteosarcomas

A

Parosteal and periosteal subtypes

177
Q

Most common type of surface osteosarcoma and tends to occur in older patient population

A

Parosteal subtype

178
Q

Intermediate-grade osteosarcoma lesions which are thought to arise from the deep layers of the periosteum and arise in patients of the same age as conventional osteosarcoma

A

Periosteal osteosarcoma

179
Q

Type of osteosarcoma that tend to arise in the diaphysis with the femur and tibia representing the most common location

A

Periosteal osteosarcomas

180
Q

Treatment of osteosarcoma

A

Combination of chemotherapy and surgery

181
Q

True or false: osteosarcoma is not radiosensitive

A

True

182
Q

Small, round, blue cell tumor of childhood and belongs to the family of tumors including extraosseous Ewing sarcoma, Askin tumor and primitive neuroectodermal tumors (PNET)

A

Ewing sarcoma

183
Q

Second most common primary malignant bone tumor in children and adolescents with an annual incidence of approximately 200 cases

A

Ewing sarcoma

184
Q

Ewing sarcoma is most frequent in the ____ decades of life, with peak incidence between what age

A

3 decades of life, peak between 10-20 years of age

185
Q

Gender predominance of ewing sarcoma

A

Male

186
Q

True or false:ewing sarcoma is uncommon in african-american and asian populations

A

True

187
Q

Ewing sarcoma most commonly occurs in what bones

A

Extremities, ribs and pelvis

188
Q

Most commonly involved bone in ewing sarcoma

A

Femur

189
Q

Ewing sarcoma Lesions in long bones typically arise in the

A

Metadiaphysis and diaphysis

190
Q

Has an aggressive appearance with bone destruction leading to a moth-eaten or permeative pattern. There is usually periosteal reaction which may appear lamellated (onion-skin like). An associated soft tissue mass is also a common finding and the mass tends to be much larger in size in comparison to the amount of underlying bone destruction

A

Ewing sarcoma

191
Q

Most common malignancy of children

A

Acute leukemia

192
Q

Most common type of leukemia

A

Acute lymphoblastic leukemia

193
Q

Peak incidence of ALL

A

2-3 years of age

194
Q

Most common skeletal finding in leukemia

A

Diffuse demineralization

195
Q

So called “leukemic lines” seen in 50% of patients with skeletal findings. They are non specific and seen as a uniform and regular lucency across the width of metaphysis in those bones associated with rapid growth such as the distal femurs, proximal tibia/humeri, vertebral bodies and iliac crests

A

Transverse lucent metaphyseal bands

196
Q

Benign vascular tumors and is the most common vascular tumor of infancy

A

Hemangioma

197
Q

Vascular lesion that follows a characteristic clinical pattern:they are not present at birth, although sometimes a precursor lesion such as discoloration or macule may be present. There is rapid growth after birth during the proliferative phase, with a peak at about 1 year of age. An involuting phase follows with spontaneous regression and decrease in size over many years. Final stage is a fibrotic stage with small residual fibrofatty tissue remaining for life

A

Hemangioma

198
Q

Most commonly involved organ in infantile hemangioma

A

Skin followed by the liver

199
Q

Infanfile hemangioma are associated with what syndromes

A 
PHACE sydrome (posterior fossa brain malformations; hemangiomas of the face, neck or scalp;arterial anomalies; coarctation of the aorta and cardiac defects; and eye abnormalities)
LUMBAR syndrome (lower body infantile hemangiomas, urogenital anomalies, ulceration, myelopathy, bony deformities, anorectal malformations, arterial anomalies and renal anomalies)
200
Q

Congenital hemangiomas can be distinguished from infantile hemangiomas clinically as they at birth because of the

A

Proliferative phase occurs in utero

201
Q

Primary diagnostic imaging modality for hemangiomas

A

Ultrasound

202
Q

Spectral doppler of hemangiomas will show

A

Low resistance arterial waveforms

203
Q

On color doppler imaging, hemangiomas appear as

A

Marked vascularity with 5 or more vessels per square centimeter

204
Q

As hemangiomas involutes, it will appear

A

Show decreased vascularity and increased echogenicity

205
Q

Of note, this should not be present in hemangiomas

A

Perilesional edema

206
Q

Treatment for hemangioma

A

No tx required unless for loss of function or cosmetic issues, medical tx with propanolol and possibly embolization or surgery may be performed

207
Q

Aka pseudotumor of infancy or sternomastoid pseudotumor.

A

Fibromatosis coli

208
Q

Usually manifests at about 2 weeks of life with a palpable mass in the sternocleidomastoid muscle

A

Fibromatosis colli

209
Q

Fibromatosis colli is usually unilateral or bilateral?

A

Unilateral

210
Q

True or false: fibromatosis colli is more commonly right-sided and can cause torticollis

A

True

211
Q

Majority of cases of fibromatosis colli resolve by what age

A

2 years of age

212
Q

Treatment for fibromatosis colli

A

Conservative: stretching and physical therapy

213
Q

Heterogeneous group of disorders which are characterized by abnormal bone and cartilage growth

A

Skeletal dysplasias

214
Q

Long bone dysplasias affecting the proximal portions of extremities

A

Rhizomelia

215
Q

Dysplasias affecting the middle portion of long bones

A

Mesomelia

216
Q

Dysplasias affecting the distal portion of long bones

A

Acromelia

217
Q

Shortening of the entire extremity

A

Micromelia

218
Q

Most common non lethal skeletal dysplasia and patients have normal mentation and life span

A

Achondroplasia

219
Q

Patients have rhizomelia, frontal bossing and small/narrow foramen magnum, thorax is small with shortened ribs, narrowing of rhe interpedicular distance particularly in the more caudal segments of lumbar spine and posterior vertebral body scalloping and gibbus deformity. Iliac wings may be rounded, with flat acetabular roofs, narrow sacrosciatic notches and a champagne glass-shaped pelvic inlet, hands show brachydactyly with trident configuration. Femurs show scooped out appearnce while the distal femur has a deep notch in the central growth plate (chevron deformity) and there is fibular overgrowth

A

Achondroplasia

220
Q

On of the most common lethat skeletal dysplasia, with features such as “clover-lead” skull due to craniosynostosis, curved long bones including “French Telephone reciever” appearance to the femurs, platyspondyly, short rivs and handlebar clavicles and micromelia

A

Thanatophoric dwarfism

221
Q

Presence of this can help distinguish thanatophoric dwarfiam from other forms of dwarfism

A

Platyspondyly

222
Q

Group of metabolic disorders that involve the defective activity of the lysosomal enzymes which blocks degradation of mucopolysaccharides. Most commin subtypes are Hunter, Hurler, Sanfilippo and Morquio syndromes

A

Mucopolysaccharidoses

223
Q

Common features include enlarged skull with J-shaped sella, paddle or oat-shaped ribs, beaking of the thoracolumbar vertebral bodies sometimes with gibbus deformity. Iliac wings are flaired and small with inferior tapering and steep acetabular roofs. Metacarpals show proximal tapering

A

Mucopolysaccharidoses

224
Q

Inherited disorder of connective tissue characterized by increased bone fragility and low bone mass. Clinical findings include blue sclera, dentinogenesis imperfecta, skin hyperlaxity and joint hypermobility

A

Osteogenesis imperfecta

225
Q

Most common type of osteogenesis imperfecta

A

Mild type 1 disease

226
Q

Main radiographic features include diffuse demineralization, fractures and deformities. Fx typically invloves the long bones and spine. Popcorn calcifications are also described at the metaphsysis/epiphysis which are secondary to ossification of the displaced and fragmented physis

A

Osteogenesis imperfecta

227
Q

Rare bone disease that results from a failure of osteoclasts to resorb bone. Decreased osteoclastic activity leads to decreased elasticity of bone, impaired repair functions and increased risk of fx. Greater risk of infection and delayed union

A

Osteopetrosis

228
Q

Hallmark of osteopetrosis

A

Increased density in the medullary portion of bone with relative sparing of the cortices

229
Q

Type of osteopetrosis that has uniform sclerosis of the long bones, skull and spine

A

Phenotypic variant Type 1

230
Q

Type of osteopetrosis that has a the “bone-within-bone” appearance and sclerosis of the skull base

A

Phenotypic type 2

231
Q

Sandwich vertebra or picture frame vertebral bodies

A

Phenotypic type 2 osteopetrosis

232
Q

Relatively common dysplasia findings and include: wide sutures, numerous wormian bones, absence/hypoplasia of clavicles and pubic bones, posterior wedging of thoracic vertebral bodies, numerous pseudoepiphyses of metacarpals and tapered distal phalanges

A

Cleidocranial dysplasia

233
Q

Aka infantile cortical hyperostosis and is characterized by presentation before the 5th month of life, hyperirritability, soft tissue swelling and bone lesions, particularly mandible involvement

A

Caffey disease

234
Q

Long bones, clavicle, scapulae and ribs can also be involved and demonstrate diaphyseal new bone formation sparing the epiphyses and metaphyses

A

Caffey disease

235
Q

True or false: caffey disease is a self-limiting process with bone remodeling and resorption occurring by age 2

A

True

236
Q

Aka von Recklinghausen disease, an autosomal dominant disorder due to mutation or deletion of NF1 gene

A

NF1

237
Q

Chromosome involved in NF1

A

17

238
Q

Characterized by formation of neurofibromas and abnormalities related to mesodermal dysplasia

A

NF1

239
Q

Most common complication of NF1

A

Spinal deformities, particularly scoliosis

240
Q

Imaging characteristics include vertebral scalloping, neuroforaminal widening, transverse process spindling and rib penciling

A

NF1

241
Q

Posterior vertebral scalloping aside from NF1, can also be seen in

A

Marfan syndrome, achondroplasia and associated with spinal tumors

242
Q

Posterior vertebral scalloping in NF1 is due to

A

Bone weakness and circumferentual dilation of dural sac

243
Q

May be one of the earliest manifestations of NF1, typically presenting within the first few years of life

A

Tibial bowing

244
Q

Tibial bowing in NF1 is usually at what direction

A

Anterolateral, tends to involve the distal diaphysis, resulting in limb shortening

245
Q

Benign positional bowing of tibia is directed

A

Posteromedially

246
Q

Characterized by impaired mineralization and ossification of cartilage and osteoid and delayed endochondral ossification in children. Results in excessive physeal cartilage, growth failure and skeletal deformities. Risks include exclusively breastfed infants and African americans

A

Rickets

247
Q

Patients with this condition manifest short stature, failure to thrice, weakness and bowing deformities

A

Rickets

248
Q

Earliest manifestation of rickets

A

Demineralization

249
Q

Findings in rickets are most prominent in what areas

A

Metaphyses of bones with the greatest growth: distal radius and ulna, distal femur, proximal tibia, proximal humerus and anterior rib ends

250
Q

One of the earliest changes at the physis in rickets is the

A

Loss of the zone of provisional calcification

251
Q

Seen in rickets due to accumulation of unossified cartilage

A

Widening, fraying and cupping of metaphysis

252
Q

True or false: distal ulnar metaphysis may normally appear cupped and should not be mistaken for rickets if the distal radial metaphysis appears normal

A

True

253
Q

Following vitamin D supplementation in rickets, changes of healing can be seen on radiographs within how many months

A

2-3 months, with mineralization of the zone of provisional calcification representing one of the earliest findings

254
Q

Due to a chronic deficiency of vitamin C, which is required for proper biosynthesis of collagen

A

Scurvy

255
Q

Pathophysiology of scurvy

A

Abnormal collagen production leading to vascular fragility along with abnormal bone matrix which occurs in the same areas of greatest bone growth as seen in rickets

256
Q

Classic signs of scurvy

A

Frankel line, trummerfeld zone or scurvy line, pelkan spur and wimberger ring sign

257
Q

Classic scurvy sign with irregular growth plate with a dense band along the metaphyseal side at the zone of provisional calcification. Peripheral extension of this line results in a pointed, “beaked” contour of the metaphysis

A

Frankel line

258
Q

Lucent line adjacent to the Frankel line, more diaphyseal in location is known as the ______ which represents accumulated hemorrhage

A

Trummerfeld zone or scurvy line

259
Q

A healing metaphyseal pathologic fracture seen as a density adjacent to the metaphysis in scurvy

A

Pelkan spur

260
Q

A thin scleroric cortex surrounding a lucent epiphysis in scurvy

A

Wimberger ring sign

261
Q

Altho radiographic findings in scurvy are non specific, these findings when present should raise suspicion for scurvy

A

Diffuse symmetric bilateral metaphyseal changes with adjacent soft tissue edema and periosteal reaction

262
Q

Most common form of heavy metal poisoning

A

Lead poisoning

263
Q

Lead lines is due to

A

Lead ion deposition in the zone of provisional calcification

264
Q

Pathophysiology of lead poisoning

A

Inhibits osteoclastic remodelling but does not affect osteoblasts and results in increased thickness and trabeculae

265
Q

Difference between lead lines and normal variant dense metaphyseal bands

A

Lead lines can be distinguished clearly from the zone of provisional calcification once interval growth has occurred, whereas normal variant dense metaphyseal bands are always contiguous with the zone of provisional calcification

266
Q

Congenital disorder which ranges from hypoplasia to complete absence of proximal femur

A

Proximal focal femoral deficiency

267
Q

Associated deformities with proximal focal femoral deficiency

A

Fibular hemimelia (up to 80%), shortened tibia, hypoplastic patella, agenesis of the cruciate ligaments, deficiency of lateral rays of the foot, talocalcaneal coalition and equinovalgus or equinovarus deformity

268
Q

Condition with excessive medial bowing of tibia, tibia vara. Result of abnormal stresses on the posteromedial proximal tibial physis, leading to delayed endochondral ossification of the medial physis. This results in asymmetric growth and varus angulation

A

Blount disease

269
Q

Most common type of blount disease and is diagnosed before 4 years of age

A

Infantile

270
Q

True or false: there is an association between increased body weight and blount disease

A

True

271
Q

Diagnosis is made on standing radiographs of lower extremities, genu varum is present as measured by the angle of intersection of lines along the midshaft of femur and tibia. There is depression, irregularity, fragmentation and beaking of proximal medial tibial metaphysis and deficiency of medial proximal tibial epiphysis

A

Blount disease

272
Q

Characteristic of Blount disease that will distinguish it from physiologic bowing

A

Unilateral and asymmetric

273
Q

Tx for blount disease

A

Surgical with hemiepiphysiodesis and guided growth with osteotomy

274
Q

An abnormal fibrous cartilaginous or bony connection between 2 of the tarsal bones

A

Tarsal coalition

275
Q

Most common tarsal coalitions

A

Talocalcaneal and calcaneonavicular

276
Q

True or false, tarsal coalitions are bilateral in 50% of cases

A

True

277
Q

Calcaneonavicular coalitions are best seen on what view

A

Oblique view

278
Q

Anteater’s nose sign: elongated appearance of anterior-superior calcaneus extending toward the navicular is seen in

A

Calcaneonavicular coalition

279
Q

Foot is is fixed in adduction, supination and in varus. Calcaneus, navicular and cuboid bones are medially rotated relative to the talus. Forefoot is pronates in relation to the hindfoot which gives rise to pes cavus

A

Congenital talipes equinovarus (clubfoot)

280
Q

Talocalcaneal coalitiona on lateral radiographs

A

Talar beaking, poor visualization of talocalcaneal joint space, rounding of lateral talar process and lack of depiction of the middle facet on lateral radiographs

281
Q

C-sign can be seen on lateral radiographs as well as C-shaped line that outlines the medial talar dome and posterior-inferior sustentaculum

A

Talocalcaneal coalition

282
Q

Treatment for coalitions

A

Casting, physical therapy, orthotocs, anti-inflammatory medications

283
Q

Four features in weight bearing radiographs of club foot

A

Hindfoot equinus with a lateral talocalcaneal angle less than 35 degrees, hindfoot varus on AP radiographs with a talocalcaneal angle of less than 20 degrees, metatarsus adductus with adduction and varus deformity of forefoot and talus to first metatarsal angle greater than 15 degrees, as well as medial subluxation of rhe navicular on talus

284
Q

Lateral view appearance of clubfoot

A

Near parallel arrangement of talus and calcaneus

285
Q

Includes a spectrum of abnormalities ranging from mild to markedly abnormal development of femoral head and acetabulum

A

Developmental dysplasia of hip

286
Q

What side of the hip is more commonly involved in DDH

A

Left

287
Q

Risk factors for DDH

A

Breech position in utero, oligohydramnios, family hx, female gender, first born

288
Q

Hip click or clunk with upward force and adduction at the hip in DDH

A

Ortolani test

289
Q

Hip click or clunk in downward force and adduction in young infants

A

Barlow test

290
Q

Primary imaging modality in screening for and evaluating DDH in children younger than 6 months of age

A

Ultrasound

291
Q

A normally positioned hip is how many percent covered by acetabulum

A

More than 50%

292
Q

Angle formed by the cortex of the ilium and acetabular roof

A

Graf alpha angle

293
Q

Normal alpha angle in hip

A

More than 60 degrees

294
Q

In older infants, AP radiographs of pelvis in neutral position allows for

A

Morphologic assessment of hips

295
Q

In older infants, frog leg lateral view can help determine

A

Whether a subluxated hip reduces

296
Q

Radiograph findings in DDH

A

Delayed femoral head ossification, shallow acetabulum, abnormal position of femoral head relative to the acetabulum

297
Q

Treatment of DDH for patients up to 6 months

A

Closed reduction with Pavlik harness

298
Q

Treatment of DDH in older infants

A

Closed surgical reduction with hip spica casting

299
Q

Excessive abduction in DDH tx is postulated to lead to

A

AVN

300
Q

Caused by traction injury during birth leading to brachial plexus palsy

A

Shoulder dysplasia

301
Q

Risk factors for shoulder dysplasia

A

Shoulder dystocia, breech presentation, forceps delivery and fetal macrosomia

302
Q

Asymmetrically small, aspherical and flattened humeral head. The glenoid will appear dysplastic with a hypoplastic scapula and there is glenoid retroversion

A

Shoulder dysplasia

303
Q

Horizontal line thru both triradiate catilages

A

Hilgenreiner line

304
Q

In hilgenreiner line, femoral head should line where

A

Within the inferior medial quadrant of the acetabulum

305
Q

Vertical line intersecting the lateral rim of the acetabular roof, drawn perpendicular to Hilgenreiner line

A

Perkins line

306
Q

C-shaped line along the inferior aspect of pubic ramus and continuing to the inferior border of the femoral neck

A

Shenton line

307
Q

Angle formed by a line through the acetabular roof and Hilgenreiner line

A

Acetabular angle

308
Q

In neonates, acetabular angle should be,

A

Less than 30 degrees and decreased as the patient ages, to less than 22 degrees at 1 year of age and older

309
Q

Angle formed from a vertical line through the center of the ossified femoral head and line along the lateral margin of the acetabular roof

A

Anterior-center edge angle

310
Q

Center-edge angle less than 20 degrees us indicative of

A

DDH

311
Q

Treatment of shoulder dystocia

A

PT and botulinum toxin injection or closed reduction

312
Q

Treatment of shoulder dystocia in older children

A

May require surgery and nerve grafting may be performed in those with multiple nerve root avulsions

313
Q

Aka constriction band syndrome comprises a wide range of congenital anomalies where fetal parts get entrapped with fibrous bands if disrupted amnion which typically leads to limb and digital amputations and contriction rings

A

Amniotic band syndrome

314
Q

Amniotic band syndrome is caused by

A

Vascular insult that occurs during

early embryogenesis

315
Q

An umbrella term that encompasses all forms of inflammatory arthritis that begin the age of 16, persist for more than 6 weeks and are of unknown etiology

A

Juvenile idiopathic arthritis

316
Q

Hallmark feature of all subtypes of JIA

A

Joint inflammation

317
Q

Pathophysiology of JIA

A

Inflammation of synovial lining, synovial hyperplasia with increased vascularity, resulting in a high cellular inflammatory pannus, pannus will eventually erode into the overlying cartlage and bone as a result of antibody deposition and degradative enzymes, leading to articular destruction

318
Q

Role of ultrasound jn JIA

A

Assess bone surface, for rapid and inexpensive method for evaluating synovial proliferation, joint fluid, cartilage thickness, cortical erosions, tenosynovitis and enthesitis

319
Q

Best noninvasive imaging modality to evaluate for inflammation of the joints, tendons and entheses in JIA. Useful in assessment of bone marrow edema as well as assessment of intra-articular structures that cannot be accessed with an ultrasound probe

A

MRI

320
Q

Goal of intervention for JIA

A

Suppress synovial and entheseal inflammation in order to prevent cartilage and bone damage

321
Q

Treatment for JIA

A

Both systemic therapy as well as direct medicinal joint injections

322
Q

X-linked congenital bleeding disorders caused by the absence or decrease of clotting factor VIII OR IX

A

Hemophilic arthropathy

323
Q

Most frequent manifestation of hemophilic arthropathy

A

Joint bleeding

324
Q

One of the earliest complications of hemarthrosis

A

Synovitis

325
Q

Synovitis is characterized by

A

Synovial hypertrophy and inflammation with neoangiogenesis and subsequent bleeding

326
Q

Commonly involved joints in hemoarthropathy

A

Knee, elbow, ankle, hip and shoulder

327
Q

Classic findings in hemarthropathy of the knee

A

Widened intercondylar notch, squared margins of patella, bulbous femoral condyles with flattened surfaces

328
Q

Classic findings in elbow hemarthropathy

A

Enlargement of radial head with a widened trochlear notch

329
Q

Findings in ankle hemarthropathy

A

Ankle deformity may arise due to undergrowth of the lateral aspect of distal tibial epiphysis

330
Q

Idiopathic inflammatory disorder of children and young adults that is characterized by exacerbations and remissions of nonbacterial osteomyelitis

A

Chronic recurrent multifocal osteomyelitis

331
Q

CRMO may be seen in conjunction with what other inflammatory conditions

A

Psoriasis and IBD

332
Q

Treatment for CRMO

A

anti-inflammatory therapies

333
Q

True or false, CRMO remains a disease of exclusion since there is no laboratory confirmation test

A

True

334
Q

Characteristic locations of CRMO

A

Mandible, medial aspect of clavicle, metaphysis of lower extremities, rib, vertebral, sacroiliac joint and pelvic (metaphyseal equivalents

335
Q

Group of genetic disorders that posses an abnormality within the hemoglobin molecule

A

Hemoglobinopathies

336
Q

2 most clinically relevant hemoglobinopathic conditions within the pediatric population

A

Sickle cell disease and beta thalassemia

337
Q

Results from a single point mutation in the beta chain of the hemoglobin molecule. This causes the hemoglobin molecules to become sticky with abnormal polymerization, deforming the rbc into classic sickle shape, resulting in microvascular occlusion and ischemic events

A

Sickle cell disease

338
Q

Sickle cell patients maintain red marrow in the majority of

A

Axial and appendicular skeleton, including ankles and wrists

339
Q

Can cause widened medullary spaces, thinned cortices, demineralization and coarsened trabecular pattern in sickle disease

A

Red marrow persistence in sickle disease

340
Q

“Hair on end” pattern in the skull, which appears as widening of the diploic space of calvarium and thinning of the inner or outer calvarial table

A

Sickle cell disease

341
Q

progressive cortical thinning and smooth biconcavity may develop in the vertebral bodies due to weakened bone and pressure effect from the adjacent disc in sickle cell disease

A

Codfish vertebrae

342
Q

Sharper depressions in the central portions of the endplates due to focal infarction can be seen in sickle cell disease causing this appearance of vertebrae

A

Lincoln log or H-shaped vertebral bodies

343
Q

Sickle cell dactylitis or “hand-foot” syndrome will affect approximately how many percent of pediatric patients with majority of patients are at what age

A

50% of pediatric patients, 6 months to 2 years of age

344
Q

Areas particularly prone to infarction in sickle cell disease

A

Small tubular bones of hands and feet

345
Q

Why is painful crisis in sickle cell dactylitis late to manifest

A

In these bones, the transformation of red marrow to yellow marrow occurs much later in sickle cell patients, making episodes uncommon after 6 years of age

346
Q

A characteristic serpiginous “double line” is described which consists of a hyperintense inner line (inflammatory response) and a hypointense outer border (reactive bone interface) in long bones of patients with sickle cell disease. Cortical infarctions can also occur, resulting in cortical thickening or “bone-in-bone” appearance secondary to layered subperiosteal new bone formation

A

Sickle cell osteonecrosis

347
Q

Sickle cell-related epiphyseal osteonecrosis is most common in what areas

A

Humeral and femoral heads and often bilateral

348
Q

Later stage of epiphyseal infarction include what radiographic findings

A

Crescentic subchondral lucency and articular irregularity and subchondral collapse and fragmentation

349
Q

Later stage epiphyseal infarctions in sickle cell disease are often more pronounced in weight-bearing joints such as the

A

Hip, where articular deformity may lead to secondary degenerative changes

350
Q

Osteomyelitis in sickle cell patients is usually due to what organisms

A

Salmonella, or other gram negative organisms such as E. Coli

351
Q

Genetic disorders affecting the Beta-globin gene that result in reduced or absent synthesis of beta globin chains, ultimately affecting erythropoiesus and red cell lifespans, resulting to anemia, hepatosplenomegaly, cardiomegaly with CHF and significant marrow expansion with secondary osseous deformities

A

Beta thalassemia

352
Q

Osseous imaging findings in beta thalassemia are due to

A

Extramedullary hematopoiesis as well as a result of iron chelation therapy which is distinctly compared with sickle cell disease

353
Q

In this blood condition, osseous changes occur due to severe anemia and a massive increased demand for rbc which produce diffuse marrow expansion of the calvarium, spine, pelvis and nearly all tubular bones

A

Beta thalassemia

354
Q

Diffuse marrow expansion in beta thalassemia results in these radiographic findings

A

Cortical thinning and resorption of cancellous bone with coarsening of trabecular markings

355
Q

Commonly involved bone in beta thalassemia

A

Ribs; expansion of head and neck of ribs

356
Q

Calvarial thickening in beta thalassemia is most prominent in what part

A

Frontal bones with thinning of outer table and prominent subperiosteal spicules, creating hair on end appearance

357
Q

Pathognomonic facial appearance of thalassemia due to marked marrow expansion in calvarium causing diminished pneumatization of paranasal sinuses. Marrow expansion in the maxillary bones may ventrally displace the central incisors and laterally displaces the orbits

A

Rodent facies

358
Q

True or false: thalassemia patients who have not undergone transfusion therapy demonstrate an infantile marrow distribution

A

True

359
Q

In thalassemia patients receiving transfusions along with chelation therapy, iron deposition will be predominantly within the ______ skeleton with hematopoietic marrow in the remainder

A

Axial skeleton

[PBR] Pediatric Imaging (5 decks)

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