Part 17 Flashcards
AVN of lunate
Keinbock’s disease
who gets Keinbock’s?
people who do manual labor
what is keinbock’s associated with?
negative ulnar variance
progressive pain + soft tissue swelling of wrist
radiographic features of Keinbock’s
initially increase in density of lunate later fragmentation and collapse mixture of sclerosis and radiolucent flattening, collapse and fragmentation altered joint congruity and biomechanics precipitates DJD
what is the possible treatment for Keinbock’s?
silastic implants
tarsal navicular AVN
Kohler’s
signs and symptoms of Kohler’s
localized pain, swelling
navicular patchy, homogenous sclerosis, collapse fragmentation
scheuermann’s disease etiology
in question, probably doesn’t represent a necrosis, likely TRAUMA
what is scheuermann’s disease?
abnormality of the discovertebral junction
usually in teens
chronic back pain, deformity and early DDD
radiology of scheuermann’s
thoracic and lumbar spine 3 continguous vertebra 5 degree anterior body wedging irregular end plates decreased disc space increased kyphosis schmorl's nodes
etiology of juvenile discogenic disease
failure of embryonic vascular channels, centrum defects, notochord clefts to disappear, leaving endplate defects
juvenile discogenic disease produces?
early degeneration, segmental dysfunction, associated pathology of the facet joint
sever’s disease
NOT a necrosis
sclerosis and fragmentation of the calcaneal apophysis represents normal anatomy
correlate clinically
calcified medullary infarct
serpiginous regions of calcification within the bone medulla
usually associated with arteriosclerosis
DDx of serpiginous regions of calcification within bone medulla
- enchondroma
- chondrosarcoma
- calcified medullary infarct
MC hemolytic anemia
sickle cell
what demographic MC gets sickle cell anemia?
african americans
signs/symptoms of sickle cell anemia
pain and swelling in hands and feet
infarct of bowel following obstruction of mesenteric arteries (abdominal crisis)
osseous changes related to infarction, AVN, marrow hyperplasia and retarded growth
those with sickle cell anemia are predisposed to what?
salmonella osteomyelitis
gallstone problems
radiographic findings of sickle cell anemia
marrow hyperplasia coarse trabeculation osteopenia long bone undertubulation hair on end skull osteonecrosis/infarct H shaped vertebra
thalassemia AKAs?
cooley’s anemia
medeterranean thalassemia
presentation of thalassemia
fatigue due to chronic anemia splenomegaly cardiomegaly gallstones marrow hyperplasia extramedullary hematopoiesis maxillary overgrowth (rodent faces)
radiology of thalassemia
coarsened trabeculation (honecomb/lace like) osteopenia erlenmeyer flask deformity
background of hemophilia
X chromosome linked bleeding disorder
female the carrier usually manifest in males
imaging for hemophilia
intra-articular soft tissue swelling radiodense effusion osteopenia square femoral condyles degeneration epiphyseal overgrowth erosions
clinical features of hemophilia
joint pain
hemophilic arthropathy
background for leukemia
malignant proliferation of WBCs
imaging for leukemia
radiolucent submetaphyseal bands osteopenia osteolytic destruction of long bone metaphysis and diaphysis periosteal reactions growth arrest lines
clinical features for leukemia
fever malaise joint pain easily bruised spontaneous bleeds
cellulitits
infection of skin, subcutaneous fat or connective tissue
osteomyelitis
infection of bone (marrow spaces)
septic arthritis
infection of joint
those who are at risk for infection
immunosuppressed diabetics post-surgical vascular insufficiency sickle-cell anemia IV drug users
where are drug addicts prone to getting infection?
spine
sacroiliac
symphysis pubis
sternoclavicular
what is the most common organism for an infection?
staph aureus
modes of infection
trauma/post surgerical UTI pneumonia skin infections open wounds or cellulitis heel sticks in infants
routes of dissemination
hematogenous (MC)
direction extension
direct implantation
postoperative
infants and young adults may present with what when they have an infection?
fever chills pain swelling loss of limb function elevated ESR elevated WBC
adult patterns of infection
fever malaise edema erythema pain
50% of those with infection previously had?
skin, respiratory or genitourinary tract infections
suppurative osteomyelitis
2-12 years
males
infantile pattern of vasuclar anatomy
metaphyseal and diaphyseal vessels may penetrate the physis (septic arthritis and osteomyelitis)
childhood pattern of vascular anatomy
1 year to physis closure, metaphyseal blood flow is slow and turbulent, metaphyseal vesself don’t penetrate physis, separate epiphysis blood supply
adult pattern of vascular anatomy
metaphyseal vessels penentrate the vanishing physis, reestablishing communication with the subarticular bone end (osteomyelitis and septic arthritis)
most common locations of hematogenous infection
knee hip ankle (distal tibia) shoulder spine
two major categories of infections
suppurative (pus)- staph
non-suppurative (TB)
suppurative osteomyelitis
bone marrow infection by (pyogenic) non tubercular organism (anything but TB) staph aureus strep pneumoniae e coli pseudomonas
clinical features of acutre infections
edema lyphadenopathy warm skin cellulitis joint pain
4 radiographic stages of osteomyelitis
latent stage (1-10 days) early stage (10-21 days) middle stage (weeks) late stage (months)
early stage of osteomyelitis
spinal lesion may approach 3 weeks
soft tissue edema
osteopenia
middle stage of osteomyelitis
permeative or lytic moth eaten descruction perosteal responase (solid laminated, codman's triangle)
buttressing/solid periosteal reaction
when additional layers of new bone are added to the exterior creating an expended osseous contour
usually associated with slow growing lesions
laminated/layered/onions skin
multiple layers of new layers of bone
alternating layers of lucency and opacity with alternating growth
can be thick or thin
can be seen in slow or aggressive lesions
classically associated with ewing’s
spiculated
linear radiating spicules of new bone
hair on end
when spiculated bone is perpendicular to the bone
sunburst
when the spiculated bone is radiating from a central focus
codman’s triangle
triangular elevation of periosteum seen at the periopheal lesion cortex junction
is one of themost aggressive forms of periosteal reaction
may be seen also with benign tumors, infections or other disorders
late stage osteomyelitis
cortical destruction draining sinus involucrum cloaca sequestrum sclerosis debris loss of joint space ankylosis chonic incomplete resolution immune deficient
sequestrum
chalky, white area representing isolated dead bone
cortical and medullar infarcts
involucrum
“bony collar” (chronic periosteal response
pus lifts the periosteum and causes new bone formation, trying to wall off the infection
cloaca
rare compilation is to devlop a squamous cell carcinoma within the channel of the cloaca
malignant transformation of cloaca
Majolin’s ulcer
