MSK - Metabolic/Hematologic Bone Disease Flashcards
What processes can cause a pseudo-permeative pattern i.e. multiple small cortical holes? (3)
Osteoporosis, hemangioma and radiation
+ multiple myeloma
Features of osteomalacia (Rickets) in children
Flared and irregular epiphyses, bowing long bones, Rachetic rosary
Most common cause of osteomalacia
Renal osteodystrophy
Signs of hyperparathyroidism
Subperiosteal resorption - most commonly radial aspect of proximal and middle 2nd and 3rd phalanges
Subchondral resorption: distal clavicle osteolysis, SI joints, proximal tibia
Osteosclerosis (spine - Rugger Jersey, or more difffuse)
Brown tumour
Salt and pepper skull
Features of acromegaly
1) Neuro: Skull thickening, enlarged sinuses and enlarged sella
2) Spade appearance of terminal tufts of distal phalanges
3) Early DJD
4) Soft tissue thickening (heel pad >2.5 cm)
List the processes associated with increased bone density (osteosclerosis)
Renal osteodystrophy, sickle cell, myelofibrosis, osteopetrosis, pyknodysotosis, mets, mastocytosis, paget disease, athletes, fluorosis
Features of osteopetrosis
Diffuse bony sclerosis, bone-in-bone appearance of vertebrae, sandwich vertebrae (sclerosis does not extend all the way to the end of the vertebral body), extremely brittle bones = multiple fractures
Features of pyknodysostosis (i.e. Toulouse-Lautrec)
Short stature, distal phalangeal and distal clavicle hypoplasia, delayed suture closure +/-Wormian bones, diffuse skeletal sclerosis including spine
Imaging findings scurvy
Osteopenia
Subperiosteal hemorrhage
Dense metaphyseal calcification (Frankel) with underlying lucency (Trummerfeld)
Wimberger ring sing (opaque ring around epiphyses)
Pelkin spur (result from metaphyseal cupping)
Imaging findings osteomalacia
Osteopenia Looser zone (cortical stress fracture most commonly seen in medial proximal femur, scapula and pubic bones)
Imaging findings acromegaly
- Gigantism due to longitudinal growth when growth plates still open
- Spade-like tufts, beak-like osteophytes metacarpal heads, joint space widening/narrowing
- Enlarged jaw, frontal sinuses and thick skull
- Thickening of heel-pad (~2.5 cm)
Key imaging findings in hyperPTH
- Salt and pepper skull
- Subperiosteal resorption along radial aspect of 2nd/3rd middle phalanges, proximal medial tibia
- Distal clavicle osteolysis
- Brown tumours
- Diffuse osteopenia
- Soft tissue calcification (secondary hyperPTH)
- CPPD (primary hyperPTH)
- Insufficiency fractures
What is renal osteodystrophy? Imaging findings?
Combined effects of abnormal Vitamin D metabolism (osteomalacia) and secondary hyperPTH from prolonged renal failure
- Pt with CKD also at risk for OM, AVN, amyloidosis
Imaging shows findings of osteomalacia and hyperPTH - including osteopenia, subperiosteal resorption, soft tissue calcifications, rugger jersey spine
Imaging findings in hypothyroidism
Delayed skeletal maturity**, dental immaturity, bullet-shaped vertebral bodies, Wormian bones in skull
Imaging findings in hypoPTH
Metastatic calcium deposits (in soft tissues and BG)
Imaging findings in pseudohypoPTH
Defect in PTH receptors
Short stature, short metacarpals (4th, 5th or thumb)
DDx: Turner’s syndrome
Imaging findings thyroid acropachy
Diaphyseal periosteal reaction, multiple long bones including metacarpals, metatarsals, phalanges
Most common location of Pagets
Skull - sharply marginated geographic lytic region (osteoporosis circumscripta), cotton wool skull (mixed phase)
Vertetebral bodies - picture frame or ivory vertebra
Pelvis - trabecular coarsening, cortical thickening (look at iliopectineal and ilioischial line)
Long bones - prox to distal, lytic, blade of grass/flame shaped margins, eventual bowing and coxa vara
Complications of Paget’s (4)
Pathologic fracture, malignant degeneration to osteosarcoma**, secondary GCT, secondary OA
Imaging findings Gaucher disease (lysosomal storage disease)
- BONE INFARCTS
- Erlenmeyer flask deformity long bones
- H-shaped vertebral bodies
- Hepatosplenomegaly (big spleen, versus auto-infarcted spleen in sickle cell)
Findings in Sickle Cell Disease
Bone infarcts AVN H-shaped vertebral bodies Dactylitis in young children** Osteomyelitis (typically Salmonella) Marrow replacement (diffuse low T1 signal, medullary expansion) Osteopenia + inc. risk insufficiency fracture Hair on end striations (skull)
Imaging findings in thalassemia
- Hair on end skull
- Maxillary hypertrophy
- Diffuse osteopenia in the pelvic bones (cortical thinning, medullary expansion, coarsened trabeculations)
- Extra-medullary hematopoiesis
- Expanded ribs
- Hepatosplenomegaly
