***Systemic Bone Disease (PASS)*** Flashcards
All encompassing definition for increased radiolucency of bone?
Osteopenia
What are 5 examples of Osteopenia?
- -Osteoporosis
- -HPT
- -Rickets
- -Scurvy
- -Neoplasm
Bone density decreased in majority of skeleton, especially axial?
Osteoporosis
What are the 2 primary causes of Osteoporosis?
- -Old age
- -Post-menopausal
What are 2 secondary causes of Osteoporosis?
- -Cushing’s disease
- -Drugs
What is another name for Cushing’s disease?
Hypercortisalism
What 2 drugs can lead to Osteoporosis?
heparin and steroids
What are 2 clinical findings of generalized Osteoporosis as it progresses?
- -increased kyphosis
- -fractures as they become apparent
What are 4 image findings w/ Generalized Osteoporosis w/in axial skeleton?
- -Loss of 2* stress trabeculae, accentuation of 1* stress trabeculae
- -Vertical striations in the vertebral bodies
- -“Pencil thin” cortices
- -Compression fractures
What is the vertical striations in the vertebral bodies called?
pseudohemangiomas
What is the most common location for compression fractures for generalized osteoporosis?
thoracic spine
Describe the location of the compression fracture for generalized osteoporosis?
anterior wedge, fish vertebra - biconcave
What are 6 image findings w/ Generalized Osteoporosis w/in appendicular skeleton?
- -Ward’s triangle
- -Cortical thinning
- -Osteopenia
- -Trabecular accentuation
- -Fractures
- -Insufficiency fractures
Where are fractures most commonly found w/ generalized osteoporosis in the appendicular skeleton?
hip and wrist
Loss of bone density confined to a region?
regional osteoporosis
What are 2 causes of regional osteoporosis?
- -Disuse
- -Reflex Sympathetic Dystrophy Syndrome
What is another name for Reflex Sympathetic Dystrophy Syndrome?
Sudeck’s atrophy
What is the most common location of regional osteoporosis?
transient regional osteoporosis of the hip
Who is most likely to get Reflex Sympathetic Dystrophy Syndrome?
people over 50
What are 4 clinical findings for Sudeck’s atrophy?
- -pain/swelling
- -redness/warmth
- -shiny skin
- -trophic skin changes
What is the treatment for regional osteoporosis?
often self limiting, takes months
What population is most likely to get transient regional osteoporosis of the hip
males, aged 20-40
What are 3 imaging findings for aggressive, regional osteopenia?
- -Cortical tunneling
- -Irregular endosteal/periosteal resorption
- -Spotty and/or bank-like bone loss
What are 2 imaging findings for soft tissue changes for regional osteopenia?
- -Swelling w/ Sudeck’s atrophy
- -Atrophy w/ disuse
A focal loss of bone density affecting a small area?
localized osteoporosis
What are 3 causes of localized osteoporosis?
- -inflammatory arthritis
- -focal tumors
- -infection
What is the imaging finding for localized osteoporosis?
focal loss of bone density
–(w/ other findings of underlying cause)
Relatively normal bone quantity, poor bone quality.
osteomalacia
What is result on bones from osteomalacia?
result in soft bones
What are 4 common causes of Osteomalacia?
- -Deficiency in Ca+, P+
- -Vit D malabsorption
- -Renal lesions
What are 3 uncommon causes of Osteomalacia?
- -dysplasia
- -tumor
- -drug reax
What are 6 imaging findings for Osteomalacia?
- -Generalized osteopenia
- -Trabecular coarsening
- -Looser lines
- -Basilar invagination
- -Acetabular protrusion
- -Bone softening deformities
Primarily a disease of the growth plates?
Rickets
What are 5 clinical findings for Rickets?
- -muscle tetany
- -weakness
- -delayed development and short stature
- -bowing deformities
- -rachitic rosary
overgrowth of cartilage near joints and costochondral junction
rachitic rosary
What are 4 imaging findings for Rickets?
- -“Paint brush” metaphyses
- -Splayed metaphyses
- -Bowing deformities
- -Rachitic rosary
Rickets usually does not manifest until after what age?
6 months of age
Scurvy is due to lack of what dietary vitamin?
Vit C
What are 2 other names for Scurvy?
- -Barlow’s disease
- -Hypovitaminosis C
What is the effect of a lack of Vit C on vascular structures
vascular fragility
What are 3 vascular findings associated w/ scurvy?
- -spontaneous hemorrhage
- -easy bruisability
- -bleeding gums
What are 6 imaging findings for Scurvy?
- -Generalized osteopenia
- -White line of Frankel
- -Wimberger’s ring
- -Pelkin’s spurs
- -Trummerfeld’s zone
- -Subperiosteal hemorrhaging
What is a dense zone of provisional Ca++?
white line of frankel
What is a well-defined ring around the epiphysis?
Wimberger’s ring
Arise from metaphyseal mragins, due to collapse of the scorbutic zone?
Pelkin’s spur
What is the lucent region adjacent to zone of provisional Ca++?
Trummerfeld’s zone
When does the subperiosteal hemorrhaging become visible?
when healing begins
What population is most likely to get HPT?
females; 30-50
What is the underlying pathology of HPT?
increased osteoclastic activity w/ fibrous tissue replacement
What is the primary etiology of HPT?
overproduction of parathormone, hypercalcemia, hypophosphatemia
What is the most common cause of primary HPT?
hypercalcemia
What is the secondary etiology of HPT?
overproduction of parathormone 2* to chronic renal disease
What is the tertiary etiology of HPT?
parathyroid gland acts independent of serum calcium levels
What populations are most commonly affected by tertiary HPT?
dialysis patients, long term renal disease
How do you distinguish the different forms of HPT w/ imaging?
cannot distinguish b/w different forms w/ imaging
What are 6 axial skeleton imaging findings of HPT?
- -Osteopenia
- -Salt and Peper skull
- -Resorption of lamina dura
- -Rugger jersey spine
- -Endplate irregularities
- -Widened SI joints and symphysis
What are the 2 appendicular skeleton imaging findings of HPT?
- -Subperiosteal resorption
- -Brown tumors
What are the 4 locations for subperiosteal resorption in the appendicular skeleton w/ HPT?
- -Radial aspect of 2nd and 3rd middle phalanges
- -Distal clavicle
- -Medial aspect of prox tibia
- -Humeral metaphyses
What are the 3 most common locations for brown tumors?
- -mandible
- -pelvis
- -ribs
Acromegaly is 2* to what?
excessive growth hormone secretion from pituitary adenoma
What are the affects of acromegaly in adults?
predominate soft tissue and membranous bone overgrowth
What are the affects of acromegaly in adolesence?
increased length of bone (gigantism)
What are 5 clinical findings for acromegaly?
- -Broad, large hands and feet
- -Prominent forehead
- -Nerve compression syndromes
- -Large body features,(especially in males)
- -Debilitating headache
What 3 skull imaging findings are associated w/ acromegaly?
- -enlarged sella turcica
- -enlarged frontal sinuses
- -prognathic mandible
What is a “lantern jaw”?
prognathic mandible (acromegally)
What is the classic, but not invariable finding of acromegaly?
enlarged sella turcica
What 3 spinal imaging findings are associated w/ acromegaly?
- -enlarged discs
- -incr. diameter of vert bodies
- -post scalloping of vert body
What 3 hands/feet imaging findings are associated w/ acromegaly?
- -spade-like tufts, widened shafts
- -enlarged joints w/ osteophytes
- -enlarged heel pad thickness
What measurement indicates enlarged heel pad thickness?
> 20-26 mm
What 2 abnormal imaging findings are associated w/ acromegaly?
- -enlarged joints
- -large thorax
What is the cause of Cushing’s?
excessive flucocorticoids which may be exogenous or endogenous
What is another name for Cushing’s disease?
hypercorticolism
What are 4 characteristic clinical findings for Cushing’s disease?
- -Moon face
- -accelerated hair growth
- -purple striae on abdomen
- -buffalo hump
What are 4 imaging findings w/ Cushing’s disease?
- -Generalized osteopenia
- -Compression fractures
- -Avascular necrosis
- -Atherosclerotic plaqueing
