Radiography - Vicki Flashcards
MR LEMONS
SMALL BLUE CELL TUMORS…
Melanoma Rhabdomyosarcoma Lymphoma Ewings Medulloblastoma Other Neuroblastoma Small cell
32 male, multiple fractures after tripping over himself walking. Complaining of slight weakness in facial muscles and decreased hearing on left. Previous multiple fractures after minor falls. X-Ray shows lots of lucent (weak) bone.
Pathology?
Radiography?
Complication?
Osteopetrosis
Spongiosa filling the medullary canal with no trabeculae
Erlenmeyer flask of tubular bones,
Pancytopenia
Causes of osteonecrosis (avascular necrosis) - KNOW
Fracture Corticosteroid use Sickle cell Alcoholism Pancreatitis Legg-Calve perthes disease
Cells w/ increased osteoid production (3)
Osteosarcoma, osteoid osteoma, osteoblastoma
Primitive round cells
Ewing sarcoma
Non-neoplastic osteoclasts and their precursors
Where?
Radiography?
Osteoclastoma (giant cell tumor)
Epiphyseal ends of long bones
Soap bubbles
69 female, hip and back pain. Skull deformity and B/L hearing loss over last 17 years. Elevated ALP, normal Ca++ and phosphate.
Primary abnormality? In what way?
What is the 2nd phase?
What is the 3rd phase?
Risks?
Paget’s disease
Osteoclast dysfunction – OVERACTIVE
Osteoblasts start trying to make up for osteoclast overactivity
Sclerotic phase
Osteosarcoma, hearing loss, high-output heart failure, tibia bowing
Osteoblast dysfunction
Osteoporosis
Defective mineralization of osteoid
Osteomalacia (Rickets)
Infarction of bone and marrow
Osteonecrosis
14 boy, 1 month history of knee pain, weight loss, pale. Densely sclerotic lesion in distal femur extending from growth late into diaphysis. Periosteum is lifted, forming angle w/ cortex.
Radiography?
Produces what? Others that do this?
How to know it’s malignant?
Osteosarcoma
Codman’s triangle
Sunburst appearance
Osteoid (Osteoid osteoma, osteosarcoma, osteoblastoma)
Weight loss, pallor
20 male, painless hard subQ mass in popliteal fossa. Has been there for years, did not change in size.
Arises in what?
Arise where?
2 possible presentations?
Complication? Signs of this? (3)
Osteochondroma
Bones of ENDOCHONDRAL origin
Metaphysis of long tubular bones
Pain on nerve impingement, or fracture
Chondrosarcoma transformation
- Continued growth after skeletal maturity, aggressive behavior, cortical irregularity
Punched-out lesions
Multiple myeloma
37, painful wrists over 3 months. Early morning stiffness. MCP joints of both hands swollen and tender. No nodules or vasculitic disease.
Associated findings? (3)
Radiography? (5)
Rheumatoid arthritis
Pannus formation and inflammatory erosion w/ swelling (MCP and IP joints), rheumatoid nodules
Radial deviation of wrist, ulnar deviation of fingers, swan-neck deformity, boutonniere deformity, Hitchhiker’s thumb
Pain in weight bearing joints after use, knee cartilage loss starting medially. No inflammation, no systemic symptoms.
Associated symptoms? (6)
Osteoarthritis
Heberden nodes (DIP joints), Bouchard nodes (PIP joints), subchondral cysts, osteophytes, eburnation, synovitis
15-year-old male presented with increasing pain in
the left upper arm of approximately 3 months’
duration and a recent onset of low-grade fever. On
physical examination, there was some local tenderness
and soft tissue swelling over the proximal and mid
thirds of the left humerus.
Ewing sarcoma
Damage to p53 gene
Osteosarcoma
Injury causing decreased blood supply
Osteonecrosis
t(11;22)
Ewing sarcoma
Failure of normal bone resorption due to defective osteoclasts
Osteopetrosis
Best way to test for soft tissue involvement of Ewing sarcoma?
MRI
Sandwich vertebrae
Osteopetrosis
A 41-year-old presented to the chiropractor’s office with ongoing right sided back, hip and knee pain for the past 6 months. This began when the patient jumped off a two meter high roof and landed on his feet. He was recently treated with four months of oral corticosteroid
therapy. X-ray and MRI of the right femur shows a disruptive mass in the head of the femur.
Which artery is most likely insufficiency?
Osteonecrosis
Medial circumflex femoral a.
How does corticosteroid therapy cause osteonecrosis?
Interferes with ability to break down lipids, thus build up and clog arteries
Double line sign on T2WI
Osteonecrosis
Rim sign
Osteonecrosis
A 35 year old school teacher was admitted to the hospital with a complaint of swelling over her left wrist. The swelling had increased gradually over the preceding year. She did not sustain any kind of trauma or suffer from any fever in the last few months. Examination revealed a diffuse fusiform swelling over the wrist and distal forearm. The overlying skin was tense. However, no signs of inflammation were visible. Movement at all joints were full in range and were painless.
Imaging looks like?
Tumor cells?
Giant cell tumor (osteoclastoma)
Soap bubbles
NON-neoplastic osteoclasts and their precursors (REACTIVE)
Localized but highly destructive resorption of bone matrix by reactive osteoclasts
Giant cell tumor (osteoclastoma)
Bulging soft tissue mass delineated by thin shell of reactive bone
Giant cell tumor (osteoclastoma)
Giant cell tumor - most common locations
Distal femur, proximal tibia
Donut sign on bone scan
Giant cell tumor
Decreased bone mass, all normal lab values
Osteoporosis
Dense, brittle bones. Normal to low calcium.
Osteopetrosis
Decreased calcium and phosphate. Increased ALP and PTH.
Osteomalacia/rickets
Increased Ca and phosphate. Decreased PTH.
Hyper-vitamin D
Mandible – triangular opacity of calcification
Osteopetrosis
Hair on end appearance
Osteopetrosis - increased hematopoietic activity
Young male, sacroiliac pain, stiff spine, uveitis, aortic regurgitation, poor chest expansion, exaggerated dorsal kyphosis
Radiography?
Ankylosing spondylitis
Bamboo spine (fusion)
