Sickle Cell Flashcards
What inherited disorder is nearly exclusive to Blacks?
Sickle cell anemia
Fragile sickled RBC’s lead to what?
increased blood viscosity, stasis,
clots and
lowered pH
Clinical and radiographic features of sickle cell relate to what kind of occlusion?
vascular occlusion
tissue infarction
marrow hyperplasia
Hand-foot syndrome is caused by vascular occlusive leads to what?
ischemia
infarction of distal parts of extremities
Sickle cell crisis in the abdomen are due to which of the following symptoms?
mesenteric vascular thrombosis
Name clinical symptoms observed sickle cell anemia?
Congestive heart failure Dactylics aka welling in fingers/toes 1st yr of life crisis jaundice cholelithiasis bone pain anemia
Sickle cell manifesting as a vaso-occlusive crises resulting in what 2 things?
bone infarcts and subperiosteal hemorrhages
What is the presentation of osteomyelitis in sickle cell anemia?
local pain and systemic features of infection
What are the radiographic features of SCA in long bones?
osteopenia coarsened trabeculae, widened metaphysis, thin cortices, bone infarcts
What are the radiographic features of SCA in spine bones?
osteopenia, endplate infarction (H-shaped vertebra), collapse, widened vascular notch, extra-medullary hematopoiesis
Radiographic features from marrow hyperplasia, ischemia, necrosis and osteomyelitis in sickle cell anemia are mc in what location?
long bones
Sickle infections are a result of what bacteria?
Salmonella
Radiographic features of infarction in short tubular bone with sickle cell anemia are as follows
ST welling
diaphyseal linenear periostitis
cortical spitting (bone in bone)
Name the MC location within short tubular bones for manifestation of an infarction?
metaphysical and diaphyseal medullary infarcts
What is the MC location of epiphyseal necrosis in sickle cell anemia short tubular bones?
Femoral
Note: features are growth disturbances, patch areas of lucency/sclerosis, bone fragmentation
What is the mc location of acute osteomyelitis?
Where w/in bone does this condition begin?
Femur, large tubular bone
metaphysis
a. What pediatric symptom is expected in acute osteomyelitis?
b. ID the specific symptom/sign observed in acute osteomyelitis to distinguish adults from pediatric.
a. Acute Hight fever
b. Insidious onset
Name the pathologic feature associated with acute osteomyelitis.
early detection on MRI
Irreversible cartilage damage w/in 48 hrs
What is an the early radiologic feature seen in acute osteomyelitis?
ST edema
Name radiologic feature expected in septic arthritis.
periarticular swelling
early widened joint space
late narrowed joint space
Destruction in septic arthritis is seen in what part of the bone?
Metaphyseal or Epiphyseal in infants and adults d/t blood supply in both areas
Prognosis of acute osteomyelitis is dependent upon what?
stage, location and pt immune status
What is the MC location of low grade/chronic osteomyelitis?
Tibia
An ill defined lucency, sclerosis, cortical thickening, No periosteal reaction or ST well, and presence of cloaca radiologic features are observed in what condition?
low grade/chronic osteomyelitis
What is PLASTIC RAGS and what condition is this nemonic associated with?
Pancreatitis Lupus Alcoholism, Atherosclerosis Steroid Therapy Trauma Idiopathic Caisson’s Disease Radiation, RA (steroids) Amyloid Gaucher’s Dz Sickle Cell Dz
associated w/ostenecrosis
What is the time frame of ischemia for marrow elements, bone cells and marrow fat?
6-12 hrs
12-24 hrs
2-5 days
A decrease of blood flow lead to what just before bone infarction?
bone ischemia
Provide at least 2 patho-mechanic mechanisms of infarction.
intra-luminal obstruction
arterial wall dz
vascular compression
physical disruption of vessel
True or False
Osteonecrosis is not visible on radiograph until the removal, remodeling and deposition stage.
True
Which of the following is the result of an articular surface collapse?
step defect
Define subchondral collapse
frx of trabecular cancellous bone just below the subchondral bone plate w/out articular surface disruption.
What is the aka for subchondral collapse?
crescent sign
what is the pathognomonic of late osteonecrosis?
Subchondral collapse
What’s the order of late osteonecrosis? In other words which is worst Crescent sign or step defect?
Step defect
What is the MC hematologic condition of bone?
osteonecrosis
Osteochondritis dissecans has what kind of necrosis occurring in pads?
focal
Avascular necrosis involvement is what type of necrosis?
junta-articular
usually in epiphysis
Early osteonecrosis will have what radiographic findings?
joint effusion
patchy density changes (lucency, sclerosis)
Bite sign
Reactive interface line, double line sign and rim sign are MRI T2 weighed findings associated with what condition?
Osteonecrosis in femoral head
What is the MC location of osteonecrosis?
femoral head
males 40-60 yrs old
Osteonecrosis in the femur head Signs/symptoms are asymptomatic seen early.. True or False
True
Note: pain in hip, butt, groin later in dz.
ID sign/symptoms of femoral head osteonecrosis?
Hip, butt, groin pain
Reduced motion
m. atrophy
Radiographic features seen in early osteonecrosis of the femur are what?
joint effusion
patchy density changes
bite sign
Radiographic features seen in late osteonecrosis of the femur are what?
subchondral collapse (crescent sign), articular collapse (step defect) deformity
What is the exact location for the development of knee osteonecrosis?
medial condyle of distal femur pt over 60 yrs old
What S/S of knee osteonecrosis?
sudden onset of knee pain
What are the radiographic features of osteonecrosis in the knee
articular cortex flattening/collapse
altered subchondral bone density
loose bodies
articular degeneration
What radiographic features are observed during the avascular stage of leg-calve-perthes?
joint effusion
medial space widening aka waldenstom’s sign
sign of joint effusion
small epiphysis
What does BME stand for?
Bone Marrow Edema
What MRI finding is associated w/pain?
Bone Marrow Edema
MR is most sensitive and demonstrates changes earlier than XR. What findings are noted on MRI?
reactive interface line
double line sign
rim sign
What is the alternating signal intensity on T2 weighted MRI and is diagnostic?
double line sign
True or False
Infarcts imply bone death but are Not at risk of bone fracture or joint frx because it stays in medullary cavity.
True
What are the radiographic signs of medullary infarct?
sclerotic lesion in metaphysis of long bone that have snakes like outlines (aka serpentine)
Osteonecrosis in the knee has what appearance?
Flattening of convex articular surface
altered subchondral bone density
subchondral frx
step defect (articular surface frx)
Osteonecrosis in head of the second metatarsal
Freiburg infraction
Osteonecrosis in humeral head
Hass dz
Kienbock dz is Osteonecrosis activity in what bony structure?
lunate
What bone structure is effected in Kohler dz?
navicular in children
Kummell dz is ostenecrotic active in what structure?
vertebral body
Osteonecrosis to the scaphoid is called?
preiser dz
Necrotic activity to the capitellum of the humerus is called?
Panner dz
Calcaneal epiphysis is damage known as?
Sever dz
What locations are location specific sub-articles for ANV?
Hip avascular necrosis
Scaphoid avascular necrosis
Name the MC sites of osteonecrosis
femoral head
femoral condyle
humeral head
scaphoid
What conditions are self limiting?
Legg-Calve-Perthes
Osgood-Schlatter’s
What self limiting conditions is caused by osteonecrosis?
Legg-Calve-Perthes
What are 3 correlations of deformity in legg-calve-perthes?
coxa vara Lg femoral head aka coxa magna fattened head aka mushroom deformity Lg greater trochanter Sagging rope
