MSK Diffuse Bone Dz Flashcards
osteoporosis –> Tscore?
< -2.5
what is Zscore?
SD from age-matched F
osteoporosis –> vit/nutrient def etiology? (4)
- osteomalacia
- alcohol
- hypoPh
- scurvy
osteoporosis –> endocrine etiology? (2)
- hyperPTH
- Cushing dz
focal osteoporosis –> etiology? (3)
- disuse
- reflex sympathetic dystrophy
- transient regional osteoporosis of hip
what is Pelkin’s fx?
metaphyseal corner fx
osteoporosis –> genetic etiology? (3)
- OI
- Gaucher dz
- anemia
scurvy –> signs? (2)
- Wimberger ring sign
- Pelkin’s fx
what is Pelkin’s fx?
metaphyseal corner fx
what is osteomalacia?
vitD def –> faulty mineralization of bone matrix
what is Looser zone? highly specific for what condition?
osteomalacia –> cortical stress fx –> fill w abnormal, poorly mineralized osteoid –> radiolucent line thru cortex
Looser zone –> MC location? (3)
- prox femur –> media
- distal scapula
- pubic bone
acromegaly –> foot –> charact finding? measuremt?
heel-pad thick >24mm
what is 1ary hyperPTH?
- Ca level?
- Ph?
PTH adenoma –> high PTH
- high Ca
- low Ph
what is 2ary hyperPTH?
- Ca level?
renal fail –> low Ca –> inc PTH
- Ca level normal
what is 3ary hyperPTH?
chronic 2ary hyperPTH –> PTH gland lose ctrl –>
hyperPTH –> hands –> subperiosteal resorb –> MC location?
2nd & 3rd middle phalanx –> radial aspect
hyperPTH –> clavicle –> subperiosteal resorb –> MC location?
acromial aspect
hyperPTH –> knee –> subperiosteal resorb –> MC location?
prox tib –> metaphysis –> medial
hyperPTH –> teeth –> subperiosteal resorb –> MC location?
lamina dura surrounding tooth socket
hyperPTH –> what other condition may occur? MC with 1ary/2ary/3ary hyperPTH?
1ary hyperPTH –> CPPD
hyperPTH –> ST calc, periosteal rxn, sclerosis –> MC with 1ary/2ary/3ary hyperPTH?
2ary
hyperPTH –> comp? (2)
- insuff fx
- lig/tendon rupture
what is renal osteodystrophy?
chronic renal fail:
- abn vit D metab –> osteomalacia
- 2ary hyperPTH
renal failure –> risk for what bone disorders? (4)
- renal osteodystrophy
- osteomyelitis
- avascular necrosis (if on steroid)
- amyloidosis (chronic dialysis)
differentiate: osteomalacia vs renal osteodystrophy –> Looser zone
osteomalacia –> Looser zone
renal osteodystrophy –> Looser zone uncommon
peds –> hypothyroid –> imaging features? (2)
- “bullet shape” vertebral body
- Wormian bones
peds –> hypothyroid –> RF for what condition?
SCFE
hypoPTH –> metastatic deposit of Ca –> MC locaiton? (2)
- subQ tissue
- basal ganglia
what is pseudo-hypoPTH?
PTH receptor defect
what is pseudo pseudo-hypoPTH?
normal PTH, normal PTH receptor –> pseudo-hypoPTH phenotype
pseudo-hypoPTH / pseudo pseudo-hypoPTH –> synd? (4)
- obese
- round facies
- short stature
- brachydactyly
pseudo-hypoPTH / pseudo pseudo-hypoPTH –> classic XR finding?
1st/4th/5th –> short metacarpal
short 4th metacarpal –> ddx? (2)
- pseudo-hypoPTH / pseudo pseudo-hypoPTH
- Turner synd
peds –> hyperthyroid –> MSK manifestation?
accel bone mature
what is thyroid acropachy? clinical presentation? (3)
rare presentation of autoimmune thyroid disease (hyperthyroid, euthyroid, hypothyroid, or even post-treatment):
- ST swell
- finger clubbing
- extremity –> diaphysis –> metacarpal/metatarsal/phalanx –> periosteal rxn
Paget dz –> epidemiology?
old adult –> >80yo
what is Paget dz?
unknown cause –> maybe paramyxovirus –> disturb osteoclastic & blastic regulation –> progressive
Paget dz –> ssx? (4)
- bone pain
- osseous enlrg/bow
- compress CN
- high output heart fail
Paget dz –> RF for what condition?
weak subchondral bone –> OA
Paget dz –> MC locations? (3)
- skull
- spine
- pelvis
Paget dz –> 3 phases?
- phase I: osteolytic
- II: mixed lytic & sclerotic
- III: sclerotic
chronic Paget dz –> imaging appearance?
“caricature” of normal bone:
- thick cortex
- coarse irreg trabeculae
- bone expand
Paget –> phase I –> skull –> typical appearance?
“osteoporosis circumscripta” –> geographic lytic region –> sharp margin
Paget –> phase II –> skull –> typical appearance?
“cotton wool”
Paget –> phase II –> spine –> typical appearance? (2)
- “picture frame” vertebra
- “ivory” vertebra
Paget –> pelvis –> typical appearance?
- asymm coarse thick trabecula
- thick iliopectineal/ilioischial line
Paget –> pelvis –> potential comp?
acetabular protrusio
Paget dz –> phase I –> long bone –> typical appearance?
osteolysis –> prox articular end –> to diaphysis –> sharp border –> “blade of grass”, “flame-shaped margin”
Paget dz –> potential comp? (4)
- path fx
- malig degen –> osteosarcoma
- 2ary giant cell tumor
- 2ary OA
what is hereditary hyperphosphatasia? (juvenile Paget)
AR –> infant-young child –> all bones –> cortex/trabecula thick, osteopenia, bowing –> severe deformity
differentiate: hereditary hyperphosphatasia? (juvenile Paget) vs Paget dz –> imaging findings?
hereditary hyperphosphatasia? (juvenile Paget):
- diffuse
- spare articular ends
Paget:
- can be multifocal, but not diffuse
- involve articular ends
what is osteopetrosis?
osteoclast –> carbonic anhydrase def –> unable to resorb bone
osteopetrosis –> general imaging appearance?
entire skeleton –> diffuse marked sclerosis
osteopetrosis –> potential comp?
extremely brittle bones –> mult fx
osteopetrosis –> spine –> typical imaging appearance?
“sandwich”/”rugger jersey” vertebra
what is Gaucher dz?
AR –> glucocerebrosidase def –> cerebroside deposit –> macrophage (Gaucher cell) –> bone infarct, medulla expand, hepatosplenomeg
Gaucher dz –> long bone –> typical imaging appearance?
“Erlenmeyer flask” deformity
Gaucher dz –> spine –> typical imaging appearance?
vertebra –> endplate avascular necrosis –> “H-shape”
“H-shape”/”Lincoln log” vertebra –> ddx? (2) how to differentiate?
- Gaucher dz –> splenomeg
- sickle cell –> spleen auto-infarct
sickle cell –> osseous manifestations (3)
- bone infarct
- osteomyelitis
- marrow expand/hyperplasia
sickle cell –> bone infarct –> MC location? (2)
- femoral head
- long bone –> meta/dia-physis
what is sickle cell dactylitis (hand-foot synd)?
very young child –> hand/feet –> digits –> persistent hematopoietic marrow –> cold temp –> microvasc occlusion
sickle cell dactylitis (hand-foot synd) –> imaging appearance?
- ST swell
- periosteal rxn
marrow expansion –> ddx? (2)
- thalassemia
- sickle cell
red marrow reconversion –> MRI appearance?
T1 low signal
sickle cell –> marrow expansion –> long bone –> natural progression?
red cell production –> chronic stim –> medulla wide, trabecula coarse –> osteopenia –> insuff fx
red marrow reconversion –> skull –> imaging appearance?
- “hair on end” striation
- wide medulla
differentiate –> sickle cell vs thalassemia –> red marrow reconversion –> location?
thalassemia –> more common…:
- facial bone
- extramedullary hematopoiesis
differentiate –> sickle cell vs thalassemia –> degree of red marrow reconversion?
thalassemia –> more severe
thalassemia –> osseous hallmarks? (3)
- bone infarct
- marrow expansion
- osteomyelitis
thalassemia –> marrow expansion –> hand –> imaging appearance?
metacarpal & phalanx –> wide & square
thalassemia –> marrow expansion –> face –> imaging appearance?
marrow expansion –> obliterate paranasal sinuses –> “rodent” facies
long bone –> Erlenmeyer flask deformity –> ddx? (3)
- Gaucher
- thalassemia
- sickle cell
what is myelofibrosis?
progressive fibrosis of BM –> anemia –> splenomeg
myelofibrosis –> epidemiology?
older
myelofibrosis –> osseous appearance?
BM fibrosis –> diffuse sclerosis of bones
what is mastocytosis?
mast cells –> abn prolif
mastocytosis –> osseous appearance?
mast cells –> infiltrate BM:
- diffuse osteopenia
- diffuse sclerosis
bones –> diffuse sclerosis –> ddx? (9)
- renal osteodystrophy
- sickle cell
- myelofibrosis
- diffuse osteoblastic mets
- osteopetrosis
- pyknodysostosis
- mastocytosis
- fluorosis
- athlete (normal variant)
what is pyknodysostosis (osteopetrosis acro-osteolytica, Toulouse-Lautrec syndrome)?
AR –> bone dysplasia –> osteosclerosis & short stature
ivory vertebral body –> ddx? (3)
- osteoblastic mets
- Paget dz
- lymphoma
reflex sympathetic dystrophy –> bone scan findings?
inc uptake in all 3 phases –> inc. intra-articular
shoulder XR –> look like unilat RA, but preserved jt space –> ddx? (1)
reflex sympathetic dystrophy
marrow conversion –> order?
Extremities –> axial skeleton
1) epiphysis/apophysis
2) diaphysis
3) distal metaphysis
4) prox metaphysis
marrow re-conversion –> order?
1) spine
2) flat bones
3) metaphysis
4) diaphysis
5) epiphysis