Radio 2 Flashcards
most common arthropathy
osteoarthritis
essential findings in oa
OJ Simpson is OA
- osteophytes (spurs)
- sclerosis (increased whiteness or calcification)
- joint space narrowing (always)
most common weight bearing parts
- medial compartment of knee
- superolateral aspect of the hip
- spine (diffuse)
all must be present!
occasional findings in oa
- subchondral cyst/geode
- marked degenerative joint disease
- primary osteoarthritis
- erosions
classic findings in primary osteoarthritis
- dip, pip, base of thumb
- bilateral
- symmetric
- younger patients (female)
differential for oa
diffuse idiopathic skeletal hyperostosis
- osteophytes without sclerosis or joint space narrowing
- spurs on spine
- idiopathic
clinical and radiologic hallmarks of rheumatoid arthritis
RA! OJ is SOFT, BI, and MARGINALized by the PD
- soft tissue swelling
- osteoporosis
- joint space narrowing
- marginal erosions
- proximal distribution
- bilateral and symmetric
typical presentation of ra
- hand: proximal bilateral symmetrical
- knee: all compartments
- hip: axial migration
subgroup of hla b27 spondyloarthropathies
- negative for ra factor
- involvement of axial skeleton (vertebral bodies)
- ankylosing spondylitis
- ibd
- psoriatic arthritis
- reactive arthritis (reiter’s)
characteristics of hla b27 spondy
- bony ankylosis
- proliferative new bone formation
- predominant axial spinal involvement
what is syndesmophyte
- mostly spine
- paravertebral ossification
- as and ibd = syndesmophytes are marginal and symmetric
- reiter’s and psoriatic arthritis = non-marginal and asymmetric
sacroiliac joint involvement in spondyloarthropathies
as and ibd = bilateral and symmetric
pa and rs = bilateral asymmetric or unilateral
bony abnormalities in gout take ___ years to manifest
4-6 years
hallmarks of gout
- well defined erosions
- soft tissue nodules
- random distribution
- no osteoporosis
what is podagra
specific term for finding in 1st metatarsopahangeal joints
gout vs pseudogout
gout: monosodium urate
pseudogout: calcium pyrophosphate dihydrate crystals
classic triad of pseudogout
- pain
- cartilage calcification (chondrocalcinosis) !!! @ knee, symphysis pubis, triangular fibrocartilage
- joint destruction
- severe mimics carcot joint
pseudogout is associated with
- hyperparathyroidism
- gout
- hemochromatosis
classic findings in charcot’s joint
- severe joint destruction and fragmentation
- dislocation
- heterotopic new bone/osteophyte formation
- diabetic foot!!
most common etiology of septic arthritis
s aureus via hematogenous spread, local direct extension, or trauma
radiologic findings in septic arthritis
- soft tissue swelling and distention of joint capsule with fluid (early)
- joint space narrowing (late)
- absence of osteoporosis
- bone destruction and ankylosis
radiologic findings in tb arthritis
- earliest sign: joint effusion
- cartilage preservation at sites of weight bearing
phemister triad of classical signs:
- periarticular osteoporosis
- gradual joint space narrowing
- peripheral bone erosion
bone infection in adults vs children
read
how to diagnose acute osteomyelitis
- 10-12 day lag of symptoms and radio findings
- earliest sign: soft tissue swelling
- bone scan very sensitive
radio sign for bone abscess
sharply outlined area of rarefaction or lucency in metaphysis surrounded by irregular dense sclerosis
subacute vs chronic osteomyelitis
subacute >2 w
chronic >1 mo
sequestrum and involcrum in osteomyelitis
- sequestra: necrotic avascular area
- involucrum: shell of bone that cloaks sequestrum
what is infectious spondylitis
- osteomyelitis in vertebra
- hematogenous
- vertebral body > disc > endplate
radiologic findings in infectious spondylitis
- earliest: decreased disc height
- narrowing of disc space
- erosion and destruction of vertebral end plates
- paravertebral soft tissue mass
t/f tuberculous spondylitis has a greater tendency to spread in spine compared to infectious spondylitis
true
most severe form of tuberculous spndylitis
bony ankylosis
- sticking of bones
- contiguous vertebrae
what is a gibbus deformity
sharp angulation of the vertical spine
most common metabolic bone disease
osteoporosis (primary senile osteoporosis most common)
how to diagnose osteoporosis
sum the cortex of the second metacarpal and sum of the cortex should be more than 1/3 of the entire diaphysis
<1/3 = osteoporosis
osteomalacia vs osteoporosis
malacia: failure of deposition of calcium salts
porosis: deficiency of organic matrix of bone
both have finding of decreased radiographic density
uses of bone dositometry
- diagnose osteoporosis
- determine susceptibility to fractures
- monitor treatment
- postmenopausal with hormones
causes of osteomalacia in adults
- renal osteodystrophy !! (chronic renal insufficiency)
- biliary disease
- dietary insufficiency
- vitamin d deficiency
radiologic finding for osteomalacia
- less defined cortical outline
- diffuse osteopenia
- looser fracture/ looser zone/ pseudofracture
- bone softening: inward bending of pelvic sidewalls and protrusio acetabuli
radio findings in hyperparathyroidism
- subperiosteal resorption
- earliest: resorption of distal phalanx
- generalized osteopenia
- brown tumors
- chondrocalcinosis
- osteosclerosis
- rugger jersey sign (spine)
findings in pseudohypoparathyroidism
brachydactyly
findings in acromegaly
- enlarged joint spaces
- flaring up of bones
- enlarged terminal tufts of distal phalanges
- squared proximal phalanges
- frontal bossing
findings in scurvy
- wimberger’s ring
- white line of scurvy
- scurvy zone
- corner sign
vitamin d deficient rickets is common in ___
4-18 mos old
findings in vit d deficient rickets
- craniotabes (early)
- most common in knee
- rachitic rosary sign
- loss of zone of metaphyseal provisional calcification
- metaphysis is irregularly coarse, frayed, widened
- indistinct epiphyseal margins
osteosarcoma
- most common malignant primary tumor
- destructive or lyric changes with sclerosis
- malignant periosteal reaction
- soft tissue extension
findings in ewing’s sarcoma
- permeative malignancy
- partially sclerotic appearance
- onion peel periostitis
what is chrondrosarcoma
- from degeneration of osteochondroma/ enchondroma
- lytic destructive lesion with amorphous calcification
multiple myeloma
- > 40 yo
- diffuse with wide margins
- not hot on bone scan
- well defined punched out lesions (swiss cheese)
what is enchondroma
- !! benign cystic lesion of phalanges
- calcified chondroid matrix except in pahalnges
criteria for giant cell tumor
- epiphyseal and abuts articular surface
- at close epiphyses
- eccentric
- well defined border that is not sclerotic
soap bubble appearance
aneurysmal bone cyst (seen in mri, multiple fluid levels)
sites for solitary bone cyst
central, metaphyseal
calcaneus, proximal humerus, proximal femur
hallmark of avascular necrosis
- icarats
- increased bone density at an otherwise normal joint
- early: joint effusion
- patchy or mottled density
- subchondral lucency
- mr most sensitive
