Radiological Findings Tumors Exam 3 Flashcards
1
Q
Giant cell tumor
Rx findings
A
geographic -eccentric -metaphyseal-epiphyseal -subarticular -expansion/soap bubble/ purely lytic (lg holes) Cortical thinning
2
Q
Solitary osteochondrosarcoma
Rx findings
A
En face may appear dense cortical rim around an area of lucency
- sessile base lesion may cause metaphyseal widening or appear as an asym bump
- cortex and spongiosa blend imperceptibly w the host bone
- growth is at an angle to the long axis and towards the midshaft
3
Q
Hereditary multiple exostosis (HME) “diaphyseal achalsia”
Rx Findings
A
- cortex and spongiosa contiguous with host bone
- shortening of the 4th & 5th metcarpals
- supernumerary fingers and toes
- Madelung or bayonet deformity
- disproportionate shortening of extremity
4
Q
Simple/solitary/unicameral bone cyst
Rx Findings
A
- metaphseal adj to growth plate
- central, 2-3cm oval radiolucency w long axis parallel to host bone
- may be loculated w endosteal scalloping
- truncated cone appearance
- “fallen fragment sign”—aunt minnie
5
Q
Aneurysmal bone cyst
Rx findings
A
- Purely lytic & eccentric
- aggressive expansile ballooning lesion “soap bubbles”
- rapid progression in 6 wks- 3 months
- almost invisible thin cortex (CT)
6
Q
Osteoblastoma
Rx findings
A
- spinal lesions are usually radiolucent and expansile
- long bones show a progressive expansile lesion that may rapidly increase in size in 25%, metaphyseal to diaphyseal
+/- matrix calcification
7
Q
Osteoid osteoma
Rx findings
A
- cortical*: nidus in cortex, fusiform cortical thickening with 1 cm radiolucent area in…
- cancellous: may be difficult to identify with delay in dx of 4 mts- 5 yrs due to lil reactive sclerosis
8
Q
Osteoma
Rx findings
A
-well circumscribed round extremely dense lesion ~2cm in size
9
Q
Enchondroma
Rx findings
A
- round/oval lucency with fine marginal line
- endosteal scalloping
- stippled or punctuate calcifications
- possible cortical thinning and expansion
10
Q
Enchondromatosis/Ollier’s
Rx findings
A
-multiple enchondromas
11
Q
Hemangioma
Rx findings
A
Rad Spinal features:
-exaggerated vertical trabeculations: “accordion”/ “corduroy”/ “honeycomb”
- posterior bulg of cortex
- extraosseous extension beyond bony lesion causing cord compression
- paravertebral soft-tissue extension
12
Q
Chondroblastoma
Rx findings
A
- round or oval eccentric lytic lesion of an epiphysis or apophysis 1-6 cm in diameter
- well defined sclerotic margin
-lobulated in 50%
-irregular/
punctuate calcification in 25-50%
-periostitis along metaphysic in ~30-50%
13
Q
Fibrous cortical defect
Rx findings
A
- round lytic lesion 1-2 cm in diameter with a well defined sclerotic margin
- oval and extending parallel to the long asix which could produce cortical thinning and expansion
- may be multilocular
14
Q
Nonossifying fibroma
Rx findings
A
- multilocular ovoid along the long axis
- lytic lesion ~2 cm in length
- dense sclerotic border
- endosteal scalloping + thinning +/- bulging
- migrates toward diaphysis
15
Q
Paget’s disease
Rx finding
A
- Increase or decrease density
- coarsened irregular trabecular patter
- thickened cortex (internal & external)
- subarticular to diaphysis
- osseous deformity
16
Q
Paget’s disease
Skull features
A
- “osteoporosis circumscripta”-well defined lysis of the frontal and occipital regions
- “cotton wool” appearance-areas of increased density in the skull
- basilar invagination w/ foraminal encroachment
17
Q
Paget’s disease
Long bone features
A
-begins at the bone end (subarticular)
“candle flame/ blade of grass sign”- advancing edge of the lytic phase
-cortical thickening and irregular trabeculae
-bowing deformities
18
Q
Paget’s disease
Pelvic features
A
- thickening of ilopectineal line & cortical lines of the pubic bones=”rim sign”
- thickening of trabeculae
- acetabular protrusion
19
Q
Paget’s disease
Spinal features
A
- coarse vertical trabeculae
- “picture frame vertebra”
- “ivory vertebra”
- pathological collapse
20
Q
Fibrous dysplasia
Rx findings
A
- most medullary cavity lesions are lucent, loculated, or trabeculated with a thick rim of sclerosis “rind sign”
- may cause thinning of the cortex and widening of the shaft
- internal matrix is usually cloudy “ground glass appearance”
21
Q
Fibrous dysplasia
Skull features
A
- often areas of increased density along the convexity and anterior fossa
- unilateral overgrowth of the facial bone
- expansion in skull bones and ribs
22
Q
Fibrosarcoma
Rx findings
A
- can present as a well defined lucent bone lesion >5cm
- may appear as an aggressive permeative patter of destruction
- sparse periosteal reaction
- lg soft tissue mass
- sequestration of bone may be present
23
Q
Sacrococcygeal chordoma
Rx findings
A
- presacral mass avg. 10cm extending superiorly and inferiorly
- lytic midline change in sacrum and coccyx
- smophorus calcification 50% on plain film and ~70% on CT
- displacement of rectum and bladder
24
Q
Sphenooccipital chordoma
Rx findings
A
- bone destruction ~90%: clivus> sella> petrous bone> orbit> floor of middle cranial fossa> foramen magnum
- soft tissue extension into nasopharynx
- calcification/bone fragments 20-70%
25
Vertebral chordoma
Rx findings
- cervical (C2)> lumbars> thoracic
- total destruction of vertebra
- variable extension into spinal canal
- can violate disc space to involve adj bodies (common)
- anterior soft tissue mass
26
Solitary plasmocytoma
Rx findings
- typically presents as soap bubbly, highly expansile lesion
- Sparing of the posterior elements
- 70% will develop into diffuse form
Radiographic features
- conventional radiography
- bone scans may be normal
- MRI examination sensitive for marrow changes
- osteoporosis
- osteolytic defects “rain drop skull”
- osteoblastic lesions in
27
Osteosarcoma
Rx findings
Comes in various forms: central (medullary canal), parosteal (2nd mc), secondary (>60 y/o) multcentric (rare), extraosseous (increase soft tissue, telangenstatic)
Radiographic
- ill defined dense ivory or sclerotic lesion >5 cm filling medullary space
- moth-eaten medullary & cortical destruction is less common
- sunburst periosteal reaction/Codman’s
- lg soft tissue mass w/ tumor new
28
Chondrosarcoma
rx findings
round or oval area of demineralization with ill defined margins
- endosteal scalloping from pressure erosion
- popcorn matrix calcification in 2/3 with 1/3 being purely lytic
- large soft tissue mass
29
Ewing's Sarcoma
Rx findings
- 8-10 cm long lytic lesion in shaft of long bone (62% lytic, 23% mixed, 15% dense)
- moth-eaten to permeative lesion (72%) as a late findings
- “onion-skin” periosteal rxn (53%)
- cortical saucerization
- soft tissue mass formation in ~55%
- Skeletal metastasis
