skeletal surveys

Question 1

why are skeletal surveys performed

Answer 1

to detect lesions, latent pathology, pathological fx or traumatic fxs.

Question 2

what are the clinical indications that can justify having a skeletal survey?

Answer 2

• pagets disease
• skeletal dysplasia
• NAI in children
• multiple myeloma
• oncology for metastasis

Question 3

describe what pagets disease, describe its 3 phases and how it appears radiographically

Answer 3

its a disease that disrupts the replacement of old bone tissue with new bone tissue. Lytic phase, mixed phase, sclerotic bone calcification phase. lytic= osteoclasts rapidly break down bone. Mixed= osteoclasts are still resorbing bone, and osteoblasts are creating new bone. sclerotic calcification= the new bone creation is simisalr to spongy bone and calcifies, the bones can become deformed, overgorwn, bowed and break easily. on xray it looks like honeycomb (spongy bone) or can look dense and sclerotic in places. can be widespread.

Question 4

common places for pagets diseasae

Answer 4

in pelvis, skull, spine and legs

Question 5

clinical features that a person has pagets

Answer 5

bone pain, obvious deformity, swelling, deafness, spinal cord stenosis

Question 6

what is multiple myeloma

Answer 6

a cancer of plasma cells inside the bone marrow

Question 7

what does MM do and what can it lead to

Answer 7

eat away at bone and can lead to diffuse osteopenia/osteoporosis usually in pelvis, skull, spine, ribs. it can lead to renal failure, infection, pathological fx, local pathologies, spinal cord compression.
median age 68men-70women

Question 8

another characteristic of MM

Answer 8

endosteal scalloping. where plasma cells take over forcing osteoclasts to the edge of medullary cavity and starts resorping bone and eating away at the edges.

Question 9

what is skeletal dysplasia

Answer 9

affects bone and cartilage development can result in dwarfism. most common dwarf is achondroplasia

Question 10

types of skeletal dysplasia (theat are detected invitro)

Answer 10

(over 200) achondroplasia. osteogenesis imperfecta (brittle bone disease)

Question 11

whats a more serious type of dysplasia

Answer 11

osteogenesis imperfecta

Question 12

what is achondroplasia

Answer 12

is a short limbed dwarfism resulting in early ossification of epiphyseal plates of long bones and skull

Question 13

what type of osteogenesis imperfecta is teh most serious

Answer 13

type 2. (type 1 not detecred until child walks, least serious)

Question 14

characterisitics of osteogensis imperfecta

Answer 14

fx, small thorax, abscence of a limb, duplication of fingers or toes.

Question 15

common site of metastasis

Answer 15

spine, skull, pelvis, chest

Question 16

clinical features of mets

Answer 16

they may have pain, pathological fxs, swelling, neurological signs

Question 17

radiographic appearance of mets

Answer 17

can be lucent if from thyroid or melanoma.
can be opaque/sclerotic if breast, prostate.
both- lung cancer

Question 18

what part of the spine, is mets likely to go to

Answer 18

T spine

Question 19

what do NAI studies demonstrate

Answer 19

healing fractures, other injuries that may have occured, type of injury, the appx time and date it happende, soft tissue abnormalities such as perforations, lacerations and intra abdominal injuries.

Question 20

other modalities used for NAI studies?

Answer 20

CT and skeletal scintigraphy (nuc med)

Question 21

what is a common injury for NAI children

Answer 21

corner fx (aka bucket handle). a corner fx of long bones that occur near the epiphyseal plate. it can turn into a linear “bucket handle” fx along the epiphseal plate

Question 22

symptoms of NAI

Answer 22

pinch marks, outward brusing and swelling, bruising in the TRAINGLE OF SAFETY (neck, shoulders, ears, side of face), torn lips, inner thighs, soles of feet.

Question 23

some projections for NAI

Answer 23

PA and LAT CXR
adbomen
AP both legs
AP both feet
DP coned knees/ankles
AP both arms- clav to forearms
DP both hands
lateral spine (entire spine).

Question 24

common fx or problems in children

Answer 24

corner fx
salter harris fx (fx of growth plate)
toddler fx- spiral fx of tibia
supracondylar fx- fx of distal humerus
SUFE-
DDH- need hip spiker to form socket
perthes- avascular necrosis of femoral head (do bone age hand)
rickets- soft bones due to lack of vit D
Atelectasis- collapse of part of lung
bronchiolitis- inflammation of bronchioles
galleazi- fx distal radius and DRUJ disloc.
monteggia- fx ulna and disloc of radial head

Question 25

what can be mstaken for cardiomegaly on a childs chest xray

Answer 25

large thymus

Question 26

projections for MM

Answer 26

PA/LAT CXR
LAT SKULL
AP PELVIS AND FEMORA
AP/LAT L SPINE
LAT C SPINE

Question 27

projections for pagets

Answer 27

PA AND LAT CXR
LAT SKULL
AP PELVIS AND FEMORA
AP BILAT TIB/FB
LAT ALL SPINES