skeletal surveys Flashcards
why are skeletal surveys performed
to detect lesions, latent pathology, pathological fx or traumatic fxs.
what are the clinical indications that can justify having a skeletal survey?
- pagets disease
- skeletal dysplasia
- NAI in children
- multiple myeloma
- oncology for metastasis
describe what pagets disease, describe its 3 phases and how it appears radiographically
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.
common places for pagets diseasae
in pelvis, skull, spine and legs
clinical features that a person has pagets
bone pain, obvious deformity, swelling, deafness, spinal cord stenosis
what is multiple myeloma
a cancer of plasma cells inside the bone marrow
what does MM do and what can it lead to
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
another characteristic of MM
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.
what is skeletal dysplasia
affects bone and cartilage development can result in dwarfism. most common dwarf is achondroplasia
types of skeletal dysplasia (theat are detected invitro)
(over 200) achondroplasia. osteogenesis imperfecta (brittle bone disease)
whats a more serious type of dysplasia
osteogenesis imperfecta
what is achondroplasia
is a short limbed dwarfism resulting in early ossification of epiphyseal plates of long bones and skull
what type of osteogenesis imperfecta is teh most serious
type 2. (type 1 not detecred until child walks, least serious)
characterisitics of osteogensis imperfecta
fx, small thorax, abscence of a limb, duplication of fingers or toes.
common site of metastasis
spine, skull, pelvis, chest
clinical features of mets
they may have pain, pathological fxs, swelling, neurological signs
radiographic appearance of mets
can be lucent if from thyroid or melanoma.
can be opaque/sclerotic if breast, prostate.
both- lung cancer
what part of the spine, is mets likely to go to
T spine
what do NAI studies demonstrate
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.
other modalities used for NAI studies?
CT and skeletal scintigraphy (nuc med)
what is a common injury for NAI children
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
symptoms of NAI
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.
some projections for NAI
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).
common fx or problems in children
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
what can be mstaken for cardiomegaly on a childs chest xray
large thymus
projections for MM
PA/LAT CXR LAT SKULL AP PELVIS AND FEMORA AP/LAT L SPINE LAT C SPINE
projections for pagets
PA AND LAT CXR LAT SKULL AP PELVIS AND FEMORA AP BILAT TIB/FB LAT ALL SPINES
