Tutoring sessions 2 Flashcards
MRI with contrast
malignancy
acute bleed
infection
- anything with increased vascularity
MRI without contrast
radiculopathy
ligament tears
osteoma
- not looking for vascular components
after MRI what is the next step
biopsy
oma
sarcoma
benign - a few exceptions
malignant
mulitcentric osteosarcoma
rare pain in medullary canal looks like blastic mets kids fatal labs - alkaline phosphatase poor prognosis - pulmonary mets - cannonball
parosteal osteosarcoma
juxtacortical within periosteum adults well differentiated slow dull pain swelling posterior distal femur > 10 cm lobulated broad becomes larger overtime
ddx - myositis ossificans (caused by trauma) - completely separated from bone and dense in peripherry and shrinks as it gets closer to bone - shrinks over time
if something looks aggressive and we look at old films from 10 years ago and it looks aggressive then is it aggressive
no its not
secondary osteosarcoma
pagets, poly FD, HME, olliers, radiation, wilms
radium watches
post radiation sarcoma - 15 years later average
pain
liver and spleen toxicity from radiation and tumor
extraosseous osteosarcoma
non skeletal bone cancer
affects soft tissue - mc in thigh
adults
likely to mets to the lungs - cannonball mets
ddx - myositis ossificans
chondrosarcoma
cartilage cancer primary - within bone secondary - malignant transformation 3rd most common primary malignancy in adults pain and swelling pelvis, flat bones, and proximal femur cartilaginous tumor, flocculated
excision best way to get rid of - spreads by direct extension
ewings
diaphyseal and diametaphyseal sarcoma in kids
only malignancy that looks like infection
fever, anemia, leukocytosis, high ESR
onion skinning periosteal reaction
rapid, loves femur and pelvis
fibrosarcoma
eccentric expansile
metaphyseal collagen malignancy in adults
young - tubular bones around knee
older - flat bones like pelvis
malignant fibrous histiocytoma - undifferentiated pleomorphic sarcoma
secondary from - pagets, post radiation, chronic osteomyelitis
mets to the liver and lung later
high soft tissue mass
treatment - amputation
chordoma
rare notochord remnant old adults sacrococcygeal - MC 50% resection is best therapy crosses disc and spread to adjacent segments - sounds like infection but not
if you see a lit up vertebral body on xray think..
pagets
blastic mets
hodgkins lymphoma
low intensity on t1 indicates what
high intensity on t2 indicates what
something is invading the marrow
edema in the bone
