Term 3 pathology

Question 1

The lateral x ray of her thoracic spine indicates a possible pathology at the 7th
thoracic vertebra which has resulted in a loss of her overall stature (she has got
shorter and lightly more hunched).
Name the type of pathology you suspect.

Answer 1

Compression fracture

Question 2

Describe the radiographic pattern of a compression fracture at the 7th thoracic vertebra

Answer 2

Buckled anterior cortex.

Loss of height of anterior vertebral body.

Question 3

The radiographic appearance of the spine indicates uniform radiolucency.
Given the women’s age of 55 and presenting symptoms, you suspect an underlying
metabolic condition which may be affecting her skeletal system.
Name and define the condition you suspect?

Answer 3

Osteoporosis

A bone disorder in which the rate of bone resorption is greater than the rate of
bone formation

Question 4

Osteoporosis: This condition can be grouped into two types depending on age and hormonal status.
Name and describe the features of the type you suspect a woman of 55 years has.

Answer 4

TYPE 1: POST MENOPAUSAL OSTEOPOROSIS
Due to oestrogen deficiency
Loss of trabecular bone
50 – 70 years

Fractures of vertebrae
and distal radius

Question 5

Osteoporosis: List six modifiable risk factors that may affect this condition.

Answer 5

Immobilisation (sedentary = inactive / sitting all day)
Calcium deficiency (diet)
High protein diet
Alcoholism
Caffeine intake
Smoking
High dietary phosphates

Question 6

Describe the pathology regarding peak bone mass (PBM) of Osteoporosis

Answer 6

Peak bone mass (PBM) is achieved around the age of 30 – 35
PBM is greater in men and blacks
PBM can be affected by the modifiable risk factors
Bone mass begins to decrease 0.5% per year after this age
Bone mass decrease more rapidly for 3 – 7 years following menopause at 1.0%
per year
Eventually enough bone mass is loss to reach a fracture threshold level
The greater the PBM the less likely the bone loss will reach the fracture
threshold level

Question 7

You suspect a sero-negative inflammatory arthritic condition which may
present in young males.
Name the condition you suspect

Answer 7

Ankylosing Spondylitis

Question 8

State the distinguishing pathological features of Ankylosing Spondylitis

Answer 8

Bilateral sacroilitis
Ascending spinal involvement
Thoraco-lumbar region
Lumbo-sacral region
Costo-vertebral joints
Large synovial joints maybe involved

Question 9

Describe the radiographic findings you might expect to see in the sacro iliac joints
and spine if Ankylosing Spondylitis is present

Answer 9

SACROILIAC JOINT
Bilateral and
Symmetrical
Lower 2/3 of joint involved
Reactive sclerosis mainly on the ilium side of the joint

SPINE
Discovertebral junction
“Squared” vertebra on lateral film
“Barrel shaped” vertebra on lateral film
“Bamboo spine” on AP film

Question 10

Differentiate Ankylosing Spondylitis from a degenerative condition by describing the radiographic
features of osteoarthritis in the vertebral bodies and articular facet joints of the spine.

Answer 10

IVD/Vertebral body
ü Asymmetrical distribution
ü loss of height
ü Osteophytes
ü Subchondral sclerosis
ü Canal stenosis
Articular facet joint
ü Deformity/osteophytes
ü Subluxation
ü IVF encroachment
ü Sclerosis

Question 11

Describe the aetiological pathology of a prolapsed disc

Answer 11

Degenerative changes, trauma, or increased pressure may rupture the annulus
fibrosus - usually at its weakest spot - the posterior aspect where it is the
thinnest and where the posterior longitudinal ligament is the weakest
(3.5 marks for the concept of stress exceeding anatomy)
With increased pressure transmitted through the spine the nucleus pulposus
will then herniate postero-lateral or posteriorly
(1.5 mark for the concept of NP herniation)
Compressing on the roots of the spinal nerves or directly on the spinal cord

Question 12

What clinical indications of a perforated bowel would you expect to see on an x-ray image?

Answer 12

There is air under the right hemidiaphragm

Question 13

What are the clinical indications of gall stones on an x-ray image?

Answer 13

These are demonstrated as opacities

in the gallbladder.

Question 14

Name the radiographic features of small bowel obstruction.

Answer 14

Dilated loops of small bowel proximal to the obstruction

Predominantly central dilated loops

Question 15

Name some request indications that may indicate small bowel obstruction.

Answer 15

Symptoms may include abdominal (stomach) cramps and pain, bloating, vomiting, nausea, and severe constipation

Question 16

Name the radiographic features of large bowel obstruction.

Answer 16

The large bowel can distend up to approximately 6 cm in diameter
Sigmoid volvulus will be seen as a distended loop of bowel rising out of the pelvis and may have a coffee-bean configuration
There will often be proximal dilatation of the large bowel

Question 17

Name some clinical indications on a request that may indicate large bowel obstruction

Answer 17

Symptoms may include cramp-like abdominal pain and distension, constipation,nausea and vomiting. Dehydration and electrolyte imbalance may occur

Question 18

What is Sigmoid Volvulus?

Answer 18

Is a cause oflarge bowel obstructionand occurs when thesigmoid colontwists on its mesentery, thesigmoid mesocolon

Question 19

What are the radiographic features of Sigmoid volvus?

Answer 19

Sigmoid volvulus is differentiated from acaecal volvulusby its ahaustral wall and the lower end pointing to thepelvis
Will show a large, dilated loop of the colon, often with a fewgas-fluid levels.
Specific signs include a coffee bean (or kidney bean) sign, absent rectal gas, or a liver overlap sign (wherein the sigmoid loop is seen ascending to the right upper quadrant projecting over liver)

Question 20

What is Inflammatory bowel disease?

Answer 20

Is a medical term describing conditions in which the intestine becomes inflamed (red and swollen)

Question 21

What are the two main types of inflammatory bowel disease and how are they classified?

Answer 21

1. Crohn disease 2. Ulcerative colitis

Both autoimmune diseases whereby the body attacks the digestive system.

Question 22

What are the radiographic features for Crohn’s disease

Answer 22

The presence of skip lesions and discrete ulcers

Thickened folds due to edema

Question 23

What are the radiographic features for Ulcerative colitis

Answer 23

Involvement of the rectum is almost always present

May show evidence of mural thickening withthumbprinting, as seen in more severe cases

Question 24

What are kidney stones?

Answer 24

Hard deposits made of minerals and salts that form inside the kidneys and can affect any part of the urinary tract

Question 25

What is another name for kidney stones?

Answer 25

Kidney stones are also called renal calculi or urolithiasis

Question 26

What are Pelvic Phleboliths?

Answer 26

Are tiny calcifications (masses of calcium) located within venous structures found in the pelvis
They may mimic ureteric calculi
They are sometimes called “vein stones”
Thephlebolithstarts as a blood clot and hardens over time with calcium

Question 27

What is the radiographic appearance of pelvic phleboliths?

Answer 27

Pelvic phleboliths appear as focal calcifications, often with radiolucent centers
Is frequently seen on AXRs

Question 28

What are the radiographic appearance of gall stones?

Answer 28

Are radiopaque in only 15 – 20% of cases

May be laminated, radiopaque outline with lucent center