Radiographic Presentation Of Pathologies Of The Upper Limb Flashcards
How do we interpret x-rays?
ABCS approach
What is the ABCS approach?
Alignment and joint space
Bone texture
Cortices
Soft tissues
What are things to consider when interpreting x-rays?
(4)
Don’t forget to review all views
Compare both sides
Previous imaging
If you spot one abnormality, don’t lose focus until you have reviewed all areas of the image, otherwise, you might miss important pathology
What do changes in alignment and joint space (ABCS) suggest?
(4)
Fracture
Subluxation
Dislocation
(When describing the displacement, the position of the fragment distal to the fracture site is always described)
What changes can we identify by looking at the joint space?
(4)
Joint space narrowing due to cartilage loss
Cartilage calcification
New bone formation
Subchondral sclerosis (increased bone density)
Which synovial joint can osteoarthritis affect?
Any synovial joint
Are erosions a feature of osteoarthritis?
No but if they’re seen, it should raise the suspicion of inflammatory arthritis such as rheumatoid arthritis
Which age group is osteoarthritis normally found in?
The older population (around 65)
What can osteoarthritis be divided into?
(2)
Primary/concentric osteoarthritis
Secondary/eccentric osteoarthritis
What is primary/concentric arthritis?
Arthritis that can be genetic, family-based or related to activities carried out in the patient’s life
What is secondary/eccentric osteoarthritis?
Arthritis that’s caused as a result of other diseases, such as as fractures, joint instability or injuries
What type of arthritis does rheumatoid arthritis become?
A symmetrical arthritis
Which imaging modality can be used to look for erosions, synovitis and tenosynovitis?
Ultrasound
What are the key features of rheumatoid arthritis?
(4)
Erosions
Synovitis/pannus
Deformity
Symmetrical pattern
Where is rheumatoid arthritis most common?
In the hands/feet.
Why is it important to look at the bone texture (ABCS)?
Altered density or disruption to the bony trabeculae within the substance of the bone, and the bony cortex may indicate pathology
What are the 3 categories that osteomyelitis is classified into?
A bone infection that has spread through the blood stream
Osteomyelitis caused by bacteria that gain access to bone directly from an adjacent focus of injection (seen with trauma or surgery)
Osteomyelitis that is the result of diabetic foot infection or any other reason for diminished blood supply to the bones
What are the radiographic features of osteomyelitis?
(11)
Radiographic appearances may be subtle and can take from 10-14 days post infection to show up
Osteomyelitis must extend at least 1cm and compromise 30-50% of bone mineral content to produce noticeable changes on radiographs
Osteopenia
Periosteal reaction/thickkening
May appear aggressive, including the formation of a codman’s triangle
Focal bony lysis or cortical loss
Enddoseal scalloping
Loss of trabecular bone architecture
New bone apposition
Eventual peripheral sclerosis
Gas within soft tissue
What do bone metastases lead to?
(2)
Bone loss
Bone formation
What 3 patterns can bone metastases take?
Lytic (osteolytic) metastases
Sclerotic (osteoblastic) metastases
Mixed lytic and sclerotic metastases
What morphological characteristics can bone metastases have?
(3)
Diffuse
Focal
Expansile
Which primary tumours commonly metastasize to bone?
(6)
Prostate cancer (most common in males)
Breast cancer (most common in females)
Non-small cell lung cancer
Hepatocellular carcinoma
Renal cell carcinoma
Thyroid cancer
What do we use to describe bone lesions?
CAMPS
