Radiology 3 Flashcards
tumors most likely in children
benign: ABC, SBC, osteoid osteoma
malignant: osteosarcoma, Ewing sarcoma, lymphoma
tumors most likely in young adults
benign: giant cell, osteochrondroma
malignant: lymphoma, osteosarcoma
tumors most likely in older adults
benign: non usually newly found in this group
malignant: metastasis, myeloma, chondrosarcoma, lymphoma
tumors in epiphyseal or bone end
giant cell tumor
chondroblastoma
tumors in diaphyseal bones
ewing sarcoma
lymphoma
advancing/enlarging metaphyseal lesions
what do tumors look like in bone?
dense, white, “hard” appearance
what do tumors look like in cartilage?
stippled, punctate, speckled, dotted calcifications
what do tumors look like that are fibrous?
hazy, smokey, cloudy, ground glass
what do tumors look like that are lytic/lucent?
pure “empty” hole in the bone, punched out, moth-eaten
which 3 primary cancers are most likely to lead to metastasis?
lung
breast
prostate
where in the body will metastasis usually been seen?
highly vascular tissue (pedicles, metaphyses)
what’s the difference between lytic metastasis and blastic metastasis?
lytic- holes in bone
blastic- random increased densities
metastasis key possible findings
absent pedicle
polyostotic locations, multiple sized lesions, less well-defined margins
lytic, blastic, or mixed densities
usually no periosteal reaction or soft tissue mass
ivory vertebra
pathological collapse of vertebrae, could be vertebra plana
metastasis management (labs)
blood: hypercalcemia, elevated alkaline phosphatase, ESR, CRP
metastasis (imaging)
CT best for defining degree of bony destruction at each site
MRI best for evaluating marrow destruction
radionuclide scintigraphy- best for searching for multiple sites of involvement
chest films for evaluating common metastatic site
metastasis referral
oncologist
primary allopath
orthopedist
primary malignant tumors (from most common to least common)
multiple myeloma osteosarcoma chondrosarcoma ewing sarcoma lymphoma
multiple myeloma key possible findings
punched out lesions
raindrop skull
usually no soft tissue mass or periosteal reaction
pathological collapse of vertebrae, could be vertebra plana
multiple myeloma management (labs)
blood: M spike on protein electrophoresis, hyperglobinemia with reversed A/G ratio, normocytic normochromic anemia, thrombocytopenia, elevated creatine and BUN levels
urine: bence jones proteins, hypercalciuria
multiple myeloma management (imagins)
CT best for defining degree of bony destruction at each site
MRI best for evaluating marrow destruction
bone scan best for searching for multiple sites of involvement, but could be cold
chest films for evaluating common metastatic site
multiple myeloma referral
oncologist
primary allopath
orthopedic
osteosarcoma key possible findings
second most common primary malignant tumor overall, but most common for children
ages 10-25 and >60 due to malignant degeneration of “osteo” tumors
location: usually metaphysis, usually knee or humerus
aggressive and metastatic
periosteal reactions (spiculated, sunburst, laminated, codman’s triangle possible)
chondrosarcoma key possible findings
3rd most common primary malignancy 50-70 years mostly located in pelvis, metaphysis aggressive and metastatic stippled, punctate, speckled, dotted
ewing sarcoma key possible findings
4th most common primary malignancy overall, 2nd most common in children (10-25)
aggressive and malignant
located in leg bones, pelvis, anywhere
lytic, moth-eaten appearance, with laminated periosteum
key location for ewing sarcoma
diaphysis
lymphoma of bone key possible findings
5th most common primary malignancy
any age for non-hodgkin’s, 20-40 for hodgkin’s (reed-sternberg cells)
spine: ivory vertebra, compression fractures
extremities: lytic diaphysis location (mimics Ewing)
