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A DDx > MSK DDx > Flashcards

MSK DDx Flashcards

1
Q

Long Bone cortically Based Metaphyseal Lesion:

A 
Osteochondroma
Non ossifying fibroma / fibroxanthoma
Aneurysmal Bone Cyst
Insufficiency Fracture
Fatigue Fracture
Osteoid osteoma
Metastasis
Fibrous dysplasia
Adamantinoma
Benign Fibrous Histiocytoma
Langerhans Cell Histiocytosis
Cortical FIbrous Dysplasia
Cortical Chondroma.
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2
Q

Erlenmeyer Flask Deformity:

A

“Lead HOG”

  • Lead poisoning
  • Heamoglobinopathy: sickle cell, thalaessaemia
  • osteopetrosis.
  • Gaucher

“Lead CHONG”

Lead poisoning
C: craniometaphyseal dysplasia
H: Haemoglobinopathy
 - Thalaessamia
 - Sickle Cell Disease
O: osteopetrosis
N: Niemann pick disease
G: Gaucher Disease.

Bone dysplasias

  • Osteopetrosis
  • Fibrous dysplasia
  • Ollier disease
  • Multiple hereditary exostoses.
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3
Q

Beak like osteophytes of MC heads with spade like enlargement of terminal tufts:

A

Acromegaly

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4
Q

MCP Beak like osteophytes:

A

CPPD (typically 2nd and 3rd)
Haemochromotosis (more joints involved)
Acromegaly (with spade like overgrowths of distal phalanges).

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5
Q

Paediatric cervical spine ankylosis:

A

Juvenile idiopathic arthritis

Klippel Feil syndrome.

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6
Q

Eitiologies of neuropathic / Charcot Joint:

A 
Diabetes
Syringomyelia (upper extremity)
Chronic alcohol abuse
Amyloid
Spinal Tumours
Syphilis or Leprosy
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7
Q

Features of Neuropathic Joint: “5 D’s”

A 
Destruction
Dislocation
Debri
Disorganisation
no Demineralisation.
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8
Q

Bone features of Sarcoid:

A

Hands = lace like lytic lesions in middle or distal phalanges.

hands and feet:

  • acro-osteolysis
  • cyst-like lesions of the phalanges
  • hands more commonly affected than the feet
  • lace-like osteopenia

Acute or Chronic polyarthritis.
Ankle involvement especially bilateral with erythema nodosum.

Plan: CXR

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9
Q

Bony Sequestrum: “E-FILM”

A 
E: eosinophilic granuloma 
F: fibrosarcoma
I: infection (Brodie abscess)
L: lymphoma (skeletal) 
M: malignant fibrous histiocytoma or metastasis (especially from breast carcinoma)
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10
Q

4 diagnostic features of Giant Cell tumour:

A

1) Only occur with closed epiphyses
2) Lesion must be epiphyseal / flush with the articular surface.
3) Eccentrically located
4) Sharply defined zone of transition.

GCTs dont have a sclerotic border.

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11
Q

Expansile lytic lesion in posterior elements of spine:

A

Osteoblastoma
ABC
TB

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12
Q

Epiphyseal Lesion: “Evil AIG Company”

A 
E: epiphyseal:
Epiphyseal equivalent bones: 
 - Carpals, 
 - Patella, 
 - Greater trochanter, 
 - Calcaneus.

E: Eosinophilic Granuloma (<30)

A: ABC (expansile) (ABC starts in metaphysis, and can extend into epiphysis once growth plates closed)

I: Infection (closed epiphysis)

G: Giant cell tumour (adult, with closed physeal plates, abutting articular surface)

C: Chondroblastoma (child, eccentric, oedema)

Clear cell chondrosarcoma
Eosinophilic Granuloma (<30yrs).
If over 40: remove ABC / Chondroblastoma / EG, and include Mets and Myeloma.

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13
Q

Automatics for lytic lesion regardless of other features:

A 
Under 30yrs:
 - Eosinophilic granuloma
 - Infection
Over 40yrs:
 - Mets
 - Infection.
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14
Q

Sclerotic lesions:

A

> 40yrs: Mets.

Lesions that have regressed and become sclerotic:
NOF
EG
Solitary bone cyst
ABC
Chondroblastoma.
Others:
Fibrous dysplasia
Osteoid osteom
Infection
Brown tumour
Giant bone island
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15
Q

Malignant bone tumours based on age:

A 
1 - 30yrs:
 - Ewing
 - Osteosarcoma
30-40yrs:
 - Fibrosarcoma
 - Malignant Fibrous Histiocytoma
 - Malignant giant cell tumour
 - Primary lymphoma of bone
 - parosteal sarcoma
> 40yrs:
 - Mets
 - Myeloma
 - Chondrosarcoma.
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16
Q

Diffuse Bony Sclerosis: “3M’S PROOF”

A

M:Malignancy
- Mets
- Lymphoma
- Leukaemia
M: Myelofibrosis (>50yrs, spleenomegaly, extramedullary haematopoiesis).
M: Mastocytosis (thickened small bowel folds with nodules)
S: Sickle Cell Disease (Bone infarcts, H-vertebrae, splenic autoinfarction)

P: Paget disease
R: Renal osteodystrophy (sub periosteal resorption, Rugger jersey spine)
O: Osteopetrosis (diffusely dense, bone in bone, Sandwhich spine)
O: Other:
- Sclerotic dysplasias: osteopoikilosis, melorheostaosis
- Hyperthyroididm
- Hyperparathyroidism
- Pynknodysostosis (short, hypoplastic mandible, pointed and dense chalk pencil like distal phalanges)
F: Fluorosis (ligamentous calcification).

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17
Q

Shortened 4th or 5th metacarpal:

A

Pseudo hypoparathyroidism / Pseudo-pseudo hypoparathyroidism.
Turner syndrome
Post traumatic
Post infective
Sickle cell disease with secondary infarction.
Basal cell nevus syndrome.

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18
Q

Paediatric Ivory Vertebrae:

A 
Lymphoma
Osteosarcoma
Osteoblastoma
Blastic Mets:
 - Neuroblastoma
 - Medulloblastoma
 - Ewing Sarcoma
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19
Q

Adult Ivory Vertebrae:

A 
Osteoblastic Mets
 - Prostate
 - breast
Lymphoma (Paraspinal soft tissue mass)
TB
Hamangioma
Chordoma
Paget Disease of spine (expansion of vertebral body)
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20
Q

H shaped vertebrae:

A

Sickle cell disease
- Associated splenic autoinfarction
Gaucher disease:
- Spleenomegaly.

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21
Q

“THIS” Hair on end appearance skull radiograph:

A

T: Thalaessaemia
H: Hereditary Spherocytosis
I: Iron deficiency anaemia
S: Sickle Cell disease.

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22
Q

Diffusely Dense Bones algorithm:

A

Radiographic signs of secondary Hyper-PTH:
- Renal osteodystrophy

Small calcified spleen:
- Sickle Cell disease

Spleenomegaly:
- Myelofibrosis

Predominantly axial skeleton:
- Diffuse osteoblastic Mets

Pathological fractures:
- Osteopetrosis

Others:

  • Pyknodysostosis
  • Mastocytosis
  • Fluorosis
  • Athlete.
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23
Q

Expansile or lytic Rib Lesion: “FAMEB:

A

F: fibrous dysplasia (ground glass)
A: ABC (expansile)
M: Mets / myeloma (soft tissue component)
E: Enchondroma (chondroid matrix) (EG in child)
B: Brown tumour (radiographic signs of secondary hyperPTH).

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24
Q

Causes of AVN:

A 
Trauma
Steroids
Aspirin
Sickle cell disease
Collagen vascular disease
Alcohol
idiopathic

ON MRI assess for background Marrow signal to assess for diffuse symmetrical abnormality as in sickle cell, or just localised to area of AVN.

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25
Q

Bone specific AVN:

A 
Lunate = Kienbock
Navicular = Kohler disease
Metatarsal head = Freiberg infraction
Femoral head child = Perthes
Ring apophyses spine = Scheuermann's disease
Tibial tubercle = OsGood SLater Disease
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26
Q

Hand arthopathy distribution:

A 
Distal: 
 - Psoriasis
 - Reactive Arthritis
 - OA
Proximal:
 - RA
 - CPPD
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27
Q

High Riding shoulder DDx

A

CPPD
RA
Torn rotator cuff

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28
Q

SI Joint involvement patterns:

A

Symmetrical = Symmetrical Letters:

  • A: Ankylosing spondylitis
  • I: Inflammatory bowel disease

Asymmetric = Asymmmetrical Letters:

  • P: Psoriatic
  • R: Reactive.

Unilateral: consider infection.
Bilteral SI joint erosions can be seen in hyper parathyroidism as subchondral resorption.
OA / degenerative disease can also cause SI joint erosions.

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29
Q

Vertebral Body Plana DDx: “MELT”

A

M: Mets / Myeloma
E: Eosinophilic Granuloma (Child)
L: Lymphoma / Leukaemia
T: Trauma / Tb.

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30
Q

Periostitis long bone with / without underlying bone lesion:

A 
Trauma
HPOA
Venous stasis
THyroid acropachy
Pachydermoperiostosis
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31
Q

Joints that show erosions in OA:

A

TMJ
AC-J
SI-J
Symphysis Pubis

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32
Q

Syndesmophytes:

A

Symmetrical Marginal:

  • Ankylosing spondylitis
  • Inflammatory Bowel Disease

Asymmetrical Non marginal: (Arising from vertebral body)

  • Psoriatic
  • Reactive
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33
Q

Vertebral Body Focal T1 Hypointensity:

A 
Basivertebral vein
Schmorl node
Bone Island
Atypical haemangioma
Osteomyelitis
Mets
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34
Q

Vertebral Body Diffuse T1 hypointensity:

A 
Hyperplastic Marrow (isointense to muscle and discs)
Multiple Mets (hypointense to disc)
Multiple myeloma (hypointense to disc)
Lymphoma (Hypointense to disc)
Sick Cell Disease (H shaped vertebrae)
Renal Osteodystrophy
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35
Q

Pencil in Cup deformity:

A

Psoriasis
Scleroderma
RA
Reactive arthritis

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36
Q

Multiple Lytic foci in adult:

A

FEEMHI

F: fibrous dysplasia
E: eosinophilic granuloma (<30)
E: enchondroma
M: metastatic disease and myeloma/Lymphoma
H: hyperparathyroidism (brown tumours)
I: infection
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37
Q

Madelung deformity:

A 
Idiopathic
Turners syndrome
Ollier disease
Multiple hereditary exostoses (osteochondromas)
Mucopolysaccharidoses
Nail-patella syndrome`
"HIT DOC"
H: Hurler syndrome
I: infection
T: trauma
D: dyschondrosteosis
O: osteochondroma (multiple hereditary exostoses) 
C: congenital, e.g. Turner syndrome
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38
Q

Lucent metaphyseal bands (child)

A 
Leukaemia
Rickets
Osteomyelitis
Neuroblastoma Mets
Scurvy / Vitamin C deficiency
Syphillis
39
Q

Peri articular soft tissue Ca++:

A

Haemangioma

Scleroderma
Polymyositis / dermatositis (proximal thighs, sheet like)

Myositis Ossificans (intra muscular)
Tumoural Calcinosis (idiopathic, cloud like)
metastatic Calcification (dialysis / hyper PTH)

Synovial Sarcoma
Chondrosarcoma

40
Q

Chondrocalcinosis:

A

CPPD (patello femoral joint)
Hyper PTH
Haemochromotosis (Beaked osteophytes 2 -4)
Wilsons disease

41
Q

Wormian Bones:

A 
Osteogenesis Imperfecta
Cleidocranial dysostosis
Trisomy 21
Rickets
Hypophosphatasia
Hypothyroidism
42
Q

Multiple Loose Bodies:

A

Synovial Chondromatosis
PVNS
RA

43
Q

Posterior element lytic Lesion:

A 
ABC
Osteoblastoma
Infection / Tb
Mets / Myeloma
LCH
44
Q

Vertebral Body Focal T1 Hyperintensity:

A

Haemangioma
Focal fatty marrow: suppresses on FS or STIR
Pagets
Melanoma Met

45
Q

Vertebral body Diffuse T1 hyperintensity:

A

Post radiation
Heterogenous fatty marrow
Chronic Steroid therapy
Paget Disease.

46
Q

Hip Coxa Terms:

A

Coxa Profunda: acetabular wall medial to ilioischial line
Acetabular protrusio: femoral head medial to ilioischial line.
Coxa Vara: Flexed femoral neck
Coxa Valga: Straightened femoral neck
Coxa Magna: Asymmetrical circumfrential enlargement and deformation of femoral head and neck.

47
Q

Acro-Osteolysis DDx (PINCH FO):

A

P: psoriasis/pyknodysostosis
I: injury, e.g. thermal burn, frost bite
N: neuropathy, e.g. diabetes mellitus, leprosy
C: collagen vascular disease, e.g. scleroderma, Raynaud disease
H: hyperparathyroidism
F: familial, e.g. Hajdu-Cheney syndrome
O: other, e.g. polyvinyl chloride exposure, progeria, sarcoidosis

Band Like Acro Osteolysis:

  • polyvinyl chloride (PVC) exposure
  • Hajdu-Cheney syndrome
  • Hyperparathyroidism (also causes terminal tuft resorption)
  • scleroderma (also causes terminal tuft resorption)
  • idiopathic non-familial acro-osteolysis
  • pyknodysostosis (also causes terminal tuft hypoplasia)
48
Q

Causes of Sub chondral Cysts:

A

RA
OA
CPPD
Avascular necrosis.

49
Q

Epiphyseal overgrowth, gracile diaphyses +/- joint destruction.
Classically associated with widened intercondylar notch:

A

Juvenile Idiopathic arthritis
Haemophilia
Disuse secondary to paralysis.

50
Q

Rickets signs: “RICKETS”

A 
R: reaction of the periosteum
I: indistinct cortex
C: coarse trabeculation
K: knees, wrists and ankles mainly
E: epiphyseal plates widened and irregular 
T: tremendous metaphysis
S: spur (metaphyseal)​
51
Q

Finger tip lesions: “GEMS”

A

G: glomus tumor
E: epidermoid/enchondroma/subungual exostosis
M: metastasis (almost exclusively from lung)
S: sarcoidosis

52
Q

Diaphyseal lesions: “CEMENT”

A 
C: bone cysts
E: enchondroma/Ewing sarcoma
M: bone metastasis
E: eosinophilic granuloma
N: non-ossifying fibroma (NOF)
T: tuberculosis/osteomyelitis
53
Q

Wormian Bones: “PORCK CHOPS”

A 
P - pyknodysostosis
O - osteogenesis imperfecta
R - rickets
K - kinky hair syndrome
C - cleidocranial dysostosis
H - hypothyroidism/hypophosphatasia
O - otopalatodigital syndrome
P - primary acroosteolysis (Hajdu-Cheney)/pachydermoperiostosis/progeria
S - syndrome of Downs
54
Q

Calcaneal Lesions: “BIG G”

A

B: bone cyst (unicameral)
I: intraosseous lipoma
G: ganglion (intraosseous)
G: giant cell tumor

55
Q

Atraumatic pubis symphysis widening: “EPOCH”

A 
E: bladder exstrophy
P: prune belly syndrome
O: osteogenesis imperfecta
C: cleidocranial dysostosis
H: hypothyroidism
56
Q

Gracile Bones: “NIMROD”

A

N: neurofibromatosis
I: immobilization/paralysis
M: muscular dystrophy, e.g. Duchenne muscular dystrophy
R: rheumatoid arthritis (juvenile RA)
O: osteogenesis imperfecta
D: dysplasia, e.g. Marfan syndrome, homocystinuria

57
Q

Bone Cortical Lesions: “Fear Of Missing Shit Out”

A 
F: fibrosarcoma
O: osteoid osteoma
M: metastasis
S: stress fracture
O: osteomyelitis
58
Q

Dense Metaphyseal Lines: “PRINCES”

A

P: poisoning (lead, mercury, antimony, etc.)
R: rickets
I: infection (TORCH); idiopathic hypercalcemia
N: normal variant; neoplastic (leukemia, lymphoma)
C: congenital syphilis
E: endocrine (congenital hypothyroidism)
S: sickle cell disease; scurvy

Growth resumption lines post systemic illness.

59
Q

Soft tissue calcification: “My GHOSTS”

A 
My: myositis ossificans
G: gout
H: hyperparathyroidism
O: ochronosis
S: scleroderma/connective tissue diseases
T: tumoral calcinosis
S: sarcoma (synovial cell)
60
Q

Posterior vertebral element lesions: “GO TAPE”

A 
G: giant cell tumor 
O: osteoblastoma
T: tuberculosis
A: aneurysmal bone cyst
P: Paget disease
E: eosinophilic granuloma
61
Q

Osteolysis distal clavicle: “SHIRT Pocket”

A 
S: scleroderma
H: hyperparathyroidism 
I: infection (osteomyelitis) 
R: rheumatoid arthritis
T: trauma 
P: progeria
62
Q

Lucent skull lesions: “MELT ROME”

A

M: metastasis
E: eosinophilic granuloma
L: lymphoma
T: tuberculosis

R: radiation
O: osteomyelitis
M: multiple myeloma
E: epidermoid

63
Q

Elbow ossification: CRITOE

A 
C: capitellum (2yrs)
R: radial head (4yrs)
I: internal epicondyle (6yrs)
T: trochlea (8yrs)
O: olecranon (10yrs)
E: external epicondyle (12yrs)
64
Q

Permeative Bone process: “FIRE MD”

A 
F: fibrosarcoma
I: infection
R: round cell tumors (Ewing sarcoma)
E: eosinophilic granuloma
M: metastases/myeloma/malignant fibrous histiocytoma
D: desmoid tumor
65
Q

Lucent tranverse metaphyseal lines: “LINING”

A 
L: leukemia, lymphoma
I: infection (e.g. TORCHS)
N: normal variation
I: illness (systemic, such as rickets and scurvy)
N: neuroblastoma (metastatic)
G: growth arrest lines
66
Q

Multiple Lucent bone lesions: “FEEMHI”

A 
F: fibrous dysplasia
E: eosinophilic granuloma
E: enchondroma
M: metastatic disease and myeloma
H: hyperparathyroidism (brown tumors)
I: infection
67
Q

Low signal masses in synovium: “PACS”

A

P: pigmented villonodular synovitis (PVNS)
A: amyloid
C: chronic bleeding disorders, e.g. hemophilia
S: synovial osteochondromatosis

68
Q

Focal Sclerotic Bony lesion: “HOME LIFE”

A 
H: healed non-ossifying fibroma (NOF)
O: osteoma
M: metastasis
E: Ewing sarcoma
L: lymphoma
I: infection or infarct
F: fibrous dysplasia
E: enchondroma
69
Q

Cone shaped Epiphysis Causes: ABCDE MOST:

A

A: achondroplasia, acrodysostosis
B: Beckwith-Wiedemann syndrome
C: chondroplasia punctata, Cockayne syndrome, conorenal syndrome, cleidocranial dysplasia, cartilage-hair hypoplasia
D: dactylitis, Dyggve-Melchior-Clausen syndrome
E: Ellis van Creveld syndrome
M: multiple epiphyseal dysplasia, metabolic (hyperthyroidism)
O: osteomyelitis
S: sickle cell disease
T: thermal injury (burns, frostbite), trichorhinophalangeal syndrome

70
Q

Fluid fluid level bone lesion: GOATS CSF

A

G: giant cell tumor
O: osteoblastoma
A: aneurysmal bone cyst
T: telangiectatic osteosarcoma

S: sarcomas
C: chondroblastoma
S: solitary bone cyst
F: fibroxanthoma

71
Q

Bone lesions without periostitis or pain: E FUN

A

E: enchondroma
F: fibrous dysplasia
U: unicameral bone cyst
N: non-ossifying fibroma

72
Q

Lytic bone lesion surrounded by marked sclerosis: BOOST

A 
B: brodie abscess
O: osteoblastoma
O: osteoid osteoma
S: stress fracture
T: tuberculosis
73
Q

Factors favouring Chondrosarcoma over enchondroma:

A 
Pain
Cortical destruction
Scalloping of > 2/3 cortex
> 5cm in size
Changing matrix
74
Q

Arthritis with normal Bone density:

A 
OA
Erosive OA
Gout
Psoriatic arthritis
Pyrophosphate arthopathy
DISH
Haemochromatosis
Chronic reactive arthritis
PVNS
Synovial chondromatosis
Robust rheumatoid arthritis.
75
Q

Arthritis with osteopenia:

A 
Rheumatoid arthritis
Bacterial septic arthritis
Diabetic charcot arthopathy
Ankylosing spondylitis
SLE
Juvenile idiopathic arthritis
Scleroderma
Chronic reactive arthritis
Haemophillic arthopathy
76
Q

Arthritis with Productive Changes:

A 
OA
Gout
CPPD
Haemochromatosis
Impaction syndromes
Ankylosing spondylitis
Psoriatic arthritis
Osteonecrosis
77
Q

Erosive Arthritis:

A 
RA
Erosive OA
Gout
Ankylosing spondylitis
Psoriatic arthritis
Pyrophosphate arthopathy
Juvenile idiopathic arthritis
Septic arthritis
Inflammatory bowel disease arthopathy
Reactive arthritis
PVNS
Synovial chondromatosis
78
Q

Mixed erosive productive arthopathy:

A 
CPPD
Erosive OA
Gout
Ankylosing spondylitis
Psoriatic Arthritis
Inflammatory bowel disease arthritis
Haemochromotosis
79
Q

Arthritis with large subchondral cysts:

A 
OA
CPPD
RA
Gout
Chronic repetitive traumatic cysts
Particle disease
PVNS
Juvenile idiopathic arthritis
Robust RA
80
Q

Arthritis Mutilans:

A 
RA
Psoriatic arthritis
Charcot arthopathy
Juvenile idiopathic arthritis
Gout
81
Q

MCP joint predominant arthritis:

A 
RA
CPPD
Haemochromatosis
Robust RA
Juvenile idiopathic arthritis
82
Q

Interphalangeal joint predominant arthritis:

A 
OA
Psoriatic arthritis
erosive OA
Chronic reactive arthritis
amyloid
83
Q

Monoarthritis:

A 
Bacterial septic arthritis
Post traumatic OA
Gout
Viral synovitis
Neuropathic joint
PVNS
Synovial chondromatosis
Haemophillic arthopathy
84
Q

Intra articular mass:

A 
Synovial chondromatosis
PVNS
Joint bodies
Cyclops lesion
Ganglion, cruciate ligament
Displaced meniscal fragments
Nodular synovitis
RA
Lipoma aborescens
Intra articular chondroma
85
Q

Patella Lytic lesion DDx:

A

subchondral cysts - OA / CPPD
Gout

Chondroblastoma
Giant cell tumour
Brown tumour
PVNS
Dorsal defect (mimic)
Osteomyelitis
86
Q

Meniscal Tear Morphology:

A

Horizontal / Horizontal Oblique:
- Horizontal is parallel to tibial plateau, and in same plane on coronal and Sag

Vertical:

  • superior to inferior surface extension
  • Curved tear following meniscal contour, remains fixed distance from meniscal edge on Sag.

Bucket Handle:

  • Extensive vertical tear
  • Absent bow tie sign
  • Flipped fragment may be intercondylar notch, anterior displacement causing double delta sign, posterior displacement causing double PCL (medial meniscus).

Radial:

  • Vertically orientated tear perpendiclar to meniscal arc.
  • Tear changes position relative to meniscal edge on Sag = Marching cleft sign.
  • May show Ghost meniscus sign.

Presence / absence of extrusion
Presence / absence of parameniscal cysts.

87
Q

Osteochondroses Eponymous Names:

  • Kohlers:
  • Freiberg Infraction:
  • Sever’s:
  • Panner’s:
  • Perthes:
  • Kienbock:
  • Scheuermann:
  • Osgood-Schlatter:
  • sinding-Larsen-Johansson:
A

Osteochondroses Eponymous Names:

  • Kohlers: Navicular, boys 4-6
  • Freiberg Infraction: 2nd MT head,
  • Sever’s: Calcaneal apophysis
  • Panner’s: Capitellum, 5-10yrs
  • Perthes: femoral head, 4-8yrs
  • Kienbock: lunate, -ve ulna variance
  • Scheuermann: thoracic spine, 3 levels wedging with kyphosis
  • Osgood-Schlatter: tibial tubercle, fragmentation with soft tissue swelling.
  • sinding-Larsen-Johansson: inferior patella, adolescents.
88
Q

Factors favoring chondrosarcoma over enchondroma:

A 
Pain
Cortical destruction
Scalloping >2/3 cortex
>5cm in size
Changing matrix
89
Q

Calcaneal Lesions:

A

Chondroblastoma:

  • epiphysis, usually superior
  • Lucent lesion, may have internal Ca++

GCT:

  • Metaphysis growing into epiphysis (closed physis)
  • Posterior metaphysis / epiphysis usually.

Osteoid osteoma:

  • Superior epiphysis
  • Sclerotic bone surrounding lucent nidus

Osteomyelitis / Mets:
- favours posterior meta-epiphyseal region.

Solitary Bone Cyst:

  • Diaphysis, anterior 1/3 laterally
  • Sharp, thick sclerotic edge, multiloculated.
  • Fallen fragment sign, T1 dark, T2 bright.

Intra osseous lipoma:

  • Diaphysis, anterior 1/3 laterally.
  • Fat density CT/MRI
  • Central fragment.
90
Q

Candy stick appearance DDx:

A

The licked candy stick appearance refers to tapering of the tips of the metacarpal bones, metatarsal bones, phalanges or clavicles and is typically associated with chronic rheumatological conditions:

psoriatic arthropathy
rheumatoid arthritis
leprosy
neuropathic joint

The appearances result from bone resorption/destruction resembling the appearance of a candy stick that has been slowly deformed from licking.

91
Q

Super Scan Bone scan DDx:

Absent renal bladder uptake

A

Diffuse Mets: (spares or patchy skull)

  • Prostate
  • breast
  • TCC

Metabolic: (involves diffuse skull/maxilla/mandible)

  • Hyper PTH
  • osteomalacia
  • Myelofibrosis
92
Q

Poly ostotic periosteal reaction in child:

A

< 6 months:

  • Physiological: symmetrical
  • Caffey disease: mandible and clavicles, spares epiphyses.
  • Prostaglandin use
  • osteomyleitis.
  • NAI

> 6 months:

  • Juvenile idiopathic arthritis
  • Hypervitaminosis A
  • Scurvey
  • osteomyelitis.
  • NAI
93
Q

Tibial Bowing:

A

Rickets
Osteogenesis Imperfecta
NF1
achondroplasia

A DDx (14 decks)

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