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Diagnostic Imaging Exam 2 > Notes > Flashcards

Notes Flashcards

1
Q

ARTHRITIDES

A

= Arthritic conditions
Over 100 different conditions

4 Categories

  1. Inflammatory
  2. Degenerative
  3. Metabolic
  4. Infection
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2
Q

Inflammatory Arthritides

A

Characteristics:

  • Soft tissue swelling, edema
  • Uniform loss of joint space
  • Erosions
  • Cystic changes: juxta-articular osteoporosis/osteopenia
  • Monoarticular or polyarticular
  • Symmetric pattern
  • Greater predisposition to fusion (ankylosis) than degenerative or metabolic
  • Ex: Rheumatoid
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3
Q

Degenerative Arthritides

A

Characteristics:

  • Non-uniform loss of joint space
  • Osteophytes
  • Subchondral clerosis
  • Cystic changes
  • Asymmetric changes
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4
Q

Metabolic Arthritides

A

characteristics:

  • Notable soft tissue masses within periarticular soft tissues
  • Well-marginated bone lesions
  • Relative preservation of joint space
  • Overlapping degenerative and inflammatory changes is common
  • “The lumpy bumpy arthritis”
  • ex: gout
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5
Q

Infectious/Septic Arthritis

A
  • Common cause of grossly destroyed and disintegrated joints
  • Gereatest incidence is below age 30
  • Monoarticular is most common
  • Caused by blood borne pathogens and direct implantation (S. aureus is most common organism)
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6
Q

Radiological Assessment of Joints (I)

A

Plain film shows bone involvement, therefore hard to detect early disease.

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7
Q

Radiological Assessment of Joints (II)

A

Radiolographic findings lag behind clinical: 30-50% of bone must be destroyed to see it on x-ray, 3% to see on bone scan (= radionuclide scintigraphy).

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8
Q

Radiological Assessment of Joints (III)

A

Parameters:

  • Clinical evaluation
  • Age and sex
  • Distribution of joint disease
  • Readiographic appearance
  • Lab tests
  • Specialized imaging exams
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9
Q

General Age of Onset

A

0-20 Juvenile rheumatoid arthritis or other juvenile arthritis

20-40 Seronegative, seropositive joint disease/spondyloarthropathy
over 40 degenerative, DISH, gout, CPPD

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10
Q

ABCDS of Joint Diseases

A 
Alignment
Bone
Cartilage (joint space)
Distribution (consider target joints)
Soft Tissues
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11
Q

Law of Parsimony

A

Taking historical points and physical findings and putting them together into one diagnosis
but patients often have more than one arthropathy.

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12
Q

ABCDS of Joint Diseases

A 
Alignment
Bone
Cartilage (joint space)
Distribution (consider target joints)
Soft Tissues
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13
Q

DEGENERATIVE ARTHRITIS

A 
Target joints are weight-bearing articulations of the:
spine
-hips
-knee
-AC joint
-1st MTP
-1st MC-trapezium
-DIP joints
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14
Q

DEGENERATIVE ARTHRITIS

A 
Although any joint can be affected)
characteristics:
-	insidious onset
-	intermittent exacerbaions
-	aching pain, stiffness 
-	aggravation of symptoms with environmental changes such as cold and drop in barometric pressure
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15
Q

Primary DJD

A

No evidence of underlying etiology

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16
Q

Secondary DJD

A

Caused by:
Abnormal forces including obesity, trauma, joint deformity
-Pre-existing cartilage pathology such as rheumatoid arthritis, fractures and meniscal damage
-Collapse of subchondral bone, such as avascular necrosis and osteoporosis

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17
Q

DJD Other names

A 
Osteoarthritis
Osteoarthritis
Degenerative joint disease
Degenerative disc disease
Spondylosis
Arthritis
Arthrosis
Kellgren’s arthritis
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18
Q

DJD Risk Factors

A
  • Increases with age
  • Females have increase in DJD of hands, kness
  • Obesity increases DJD of knees and hips
  • Trauma – most significan local factor
  • High impact physical activity increases risk
  • Increases with inactivity or excessive activity
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19
Q

DJD Clinical Features

A
  • Poor radiographic-to-clinical correlation
  • Stiffness, especially with rest
  • Normal blood work
  • Spinal stenosis
  • Vertebrobasilar ischemia
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20
Q

DJD Progression/Development

A

Abnormal articular forces promote loss of chondroitin sulfate and interfere with normal chondrocyte function, which leads to:

  • Cartilage degradation—fissures, flaking, vascularization
  • Denudation process secondary to altered joint function
  • Synovium hypertrophy
  • Cartilaginous debris
  • Osteophytes develop from cartilage metaplasia and increased capsular insertion stresses
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21
Q

DJD Radiology Features (I)

A

Enthesopathy = pathological osseous proliferation at tendon or ligament insertion; degenerative, inflammatory [enthuses=anatomical location of insertion of ligament/tendon into bone via Sharpey’s fibers]
Ankylosis (rare, but joint may look fused)

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22
Q

DJD Radiology Features (II)

A 
Asymmetric distribution
Asymmetric loss of joint space
Osteophytes at joint margin
Subchondral sclerosis
Subchondral cysts (geodes)
Subluxation
Interarticular loose bodies
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23
Q

DJD in the Hands

A

Common, especially among middle-aged postmenopausal women

osteophytes, sclerosis, loss of joint space, misalignment

24
Q

DJD in the Hands (I)

A

Bouchard’s Nodes = enlarged soft tissue nodes of PIPs

25
Q

DJD in the Hands (II)

A

Heberden’s Nodes = enlarged soft tissue nodes of DIPs

26
Q

DJD in the Hands (III)

A

“Gull wing” – bilateral DJD with central joint erosions; variant of the normal DJD pattern

27
Q

DJD in the Hands (IV)

A 
Ungula tuft : At distal part of distal phalanges
Target Locations:
-DIPs
-PIPs
-1st metacarpal-carpal joints
-NOT MPs
28
Q

DJD in the Hands (V)

A

Ungula tuft : At distal part of distal phalanges

29
Q

Erosive Osteoarthritis (I)

A

Variant of DJD

30
Q

Erosive Osteoarthritis (II)

A

Middle aged females

Appears unusually inflammatory

31
Q

Erosive Osteoarthritis (III)

A

Middle aged females

32
Q

Erosive Osteoarthritis (IV)

A

Appears unusually inflammatory

33
Q

Erosive Osteoarthritis (V)

A

DDx: RA, psoriatic arthritis
“gull-wing” DIP joints is classic radiographic finding
pain, redness, swelling, decreased motion

34
Q

DJD in the Feet (I)

A

1st MTP joint common

35
Q

DJD in the Feet (II)

A

Hallux rigidus when present with symptoms of pain and stiffness.

Metatarsus varus

hallux valgus joint misalignment is common

36
Q

DJD in the Feet (III)

A

Bunions – enlarged head of metatarsal with cystic changes

37
Q

DJD in the Shoulder (I)

A
  1. Glenohumoral joint
    degenerative changes usually require prior trauma
    Osetophytes and joint misalignment should arouse suspicion of significant previous trauma or underlying CPPD
38
Q

DJD in the Shoulder (II)

A
  1. Acromioclavicular joint
    Often involved in DJD without prior trauma
    Osteophytes extending inferiorly may impinge on rotator cuff tendons leading to tendon calcification and superior migration of humerus
39
Q

Shoulder Impingement Syndrome

A

Rotator Cuff Arthropathy = Greater Tuberosity Enthesopathy (greater tuberosity is location of insertion of supraspinatus tendon)

40
Q

Shoulder Impingement Syndrome

A

Progression:
1. Degenerative enthesopathic changes of the humeral head, especially greater tuberosity

  1. Spurring (osteophytes)/erosions of acromion process
  2. Humerus migrates superior due to unopposed deltoid action, no room for supraspinatus
  3. Supraspinatus degeneration → rotator cuff tear: see increased signal in supraspinatus tendon on MR in the critical zone where there is less vascularity
41
Q

HADD (I)

A

Hydroxyapatite Deposition Disease

42
Q

HADD (II)

A

Deposition of calcium within tendons and bursa

43
Q

HADD (III) MC areas

A 
-Most commonly seen in the supraspinatus tendon then: 
Shoulder
Elbow
Wrist
Hip
Knee
Ankle
Spine
44
Q

HADD (IV) AKAs

A

Calcifying tendinitis, calcifying bursitis, peritendinitis calcarea

45
Q

HADD (V) Characteristics

A

Characteristics:
pain, tenderness, localized swelling reduced range of motion
-lab unrewarding
-radiographic diagnosis of calcificaiton of soft tissue involved
-focus of degeneration within tissue follows with hydroxyapatite crystal deposition
*Disc calcification is a form of HADD due to DDD.

46
Q

DJD of the Knee

A

3 compartments of the knee:

  • Medial tibiofemoral – most common compartment for DJD
  • Lateral tibiofemoral
  • Retropatellar
47
Q

Characteristics of DJD in the Knee

A
  • asymmetric loss of joint space
  • subchondral sclerosis
  • subchondral cysts
  • articular deformity and irreglarity
  • hypertrophic changes of intercondylar spines
  • enthesopathy of anterior (non-articular) surface of patella
  • genu varus in case of medial compartment degeneration
48
Q

Synovial Osteochondrometaplasia

A

Multiple intra-articular loose bodies/fragments/cartilaginous masses produced by synovial tissue metaplasia (junk in the joint)
may ultimately ossify/calcify to become visible radiographically—joint mice, with joint locking

49
Q

Synovial Osteochondrometaplasia (II)

A

Common in the knee and also seen about the

  • Hip
  • Ankle
  • Shoulder
  • Wrist
50
Q

Synovial Osteochondrometaplasia (III)

A

Seen as laminated, stippled, concentric calcific densities, unlike HADD

51
Q

Pigmented Villonodular Synovitis (PVNS) (I)

A

Slow-growing, benign and locally invasive tumor/metaplasia of the synovium

52
Q

Pigmented Villonodular Synovitis (PVNS) (II)

A

Most often involves the knee. Also in hip, ankle, elbow

Found in young to middle age adults - consider in younger patient with unexplained hip pain

53
Q

Pigmented Villonodular Synovitis (PVNS) (III)

A

DDx: rheumatoid arthritis

54
Q

Pigmented Villonodular Synovitis (PVNS) (IV)

A

Characteristics:

  • Intraarticular effusions, lobulated masses
  • Bony erosions more common in tight joints (hip, elbow, wrist)
  • Apple core deformity in hip – Concentric erosions o femoral neck
  • Seen on opposing joint surfaces
55
Q

DJD of the HIP

A

Compartments of hip joint: medial, axial, superior

56
Q

DJD of the HIP characteristics:

A
  • loss of joint space – 80% toward the superior compartment
  • osteophyte formation
  • subchondral cysts/geodes (Eggar’s cysts) – due to intra-osseous synovial intrusion through cartilage fissures along with necrosis; subchondral with sclerotic borders; can be confused with tumor when large (do MR)
  • sclerosis
  • joint deformity
  • buttressing – Thickened cortex at the medial femoral neck as result of biomechanical changes across the joint

Diagnostic Imaging Exam 2 (1 decks)

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