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Skeletal Radiology I > Unit 2 SG > Flashcards

Unit 2 SG Flashcards

1
Q

If tumor has bone density w/ soft tissue mass it is:

A

Primary osseous malignancy

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2
Q

Chondrosarcoma

A

3rd MC primary osseous malignancy

Complications: slow growing w/ late metastasis to lungs

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3
Q

Chondrosarcoma: Types

A

Primary: MC overall is central/medullary; Peripheral - osseous stalk projecting from bone

Secondary: due to malignant degeneration of enchondroma or osteochondroma

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4
Q

Chondrosarcoma: Signs and Symptoms

A

Males, 40-60 yoa

Often discovered incidentally due to pelvic soft tissue mass that interferes with bowel or bladder function

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5
Q

Chondrosarcoma: Location

A

MC primary malignant bone tumor of hand, sternum and scapula

MC overall proximal feumer; pelvis; proximal humerus

Metaphyseal (origin)

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6
Q

Chondrosarcoma: Radiographic

A

Stippled, endosteal scalloping (common w/ cartilaginous and fibrous tumors), rings (birthday present), mixed (more lytic w/ matrix calcification).
If more cloud-like = osteosarcoma
If stalk = osteochondroma

Expansile osteoLytic lesion

May have cortical destruction

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7
Q

Chondrosarcoma: DDx

A

Early may look like Enchondroma

If Ca is lacking, looks like Giant Cell

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8
Q

Benign Cartilage Forming Tumors

A

Whenever you see a CENTRAL cartilaginous lesion in a long bone, think:
Chondrosarcoma
Enchondroma
Medullary bone infarct

Any benign cartilaginous tumor can undergo malignant degeneration after being irradiated!

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9
Q

Osteochondroma

A

AKA: osteocartilaginous exostosis; coat-hanger exostosis

Cartilaginous capped bony stalk

MC benign skeletal growth

MC 10-20 yoa

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10
Q

Osteochondroma: Three Presentations

A

Solitary

Multiple

HME (Hereditary Multiple Exostosis)

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11
Q

Osteochondroma: Two Types

A

Pedunculated - stalk

Sessile - broad based (osseous base) w/ localized widening of shaft

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12
Q

Osteochondroma: Locations

A

Pedunculated - MC distal femure (metaphysis), proximal tibia

Sesile - MC humerus

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13
Q

Osteochondroma: Signs and Symptoms

A

Asymptomatic

MC complaint is hard PAINLESS mass near a joint

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14
Q

Osteochondroma: Complications

A

Fx of stalk = pn

Pressure on surrounding nerves/vessels

Malignant degeneration —> Chondrosarcoma

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15
Q

Osteochondroma: Radiographic

A

Uninterrupted merging of cortex of host bone w/ osteochondroma

Cartilaginous cap can’t be see w/o Ca

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16
Q

Osteochondroma: DDx

A

Supracondylar Process points TOWARDS the joint
MC elbow
Osteochondroma (aka coat hanger exostosis) point AWAY from joint

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17
Q

Hereditary Multiple Exostosis (HME)

A

AKA diaphyseal aclasia

Relatively common condition, malignant degeneration —> chondrosarcoma (25% of the time)

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18
Q

Hereditary Multiple Exostosis (HME): Location

A

MC metaphysis of lower extremity long bones and pelvis

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19
Q

Hereditary Multiple Exostosis (HME): Signs and Symptoms

A

MC 2-10 yoa

Usually bilateral and symmetrical

Bayonet Hand Deformity = HME

  • shortening of ulna
  • outward bowing of radius
  • subluxation of radio-ulnar joint
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20
Q

Enchondroma

A

AKA: Chondroma

MC benign tumor of hand; if you see an osteolytic lesion w/ matrix calcification in hand = ENCHONDROMA

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21
Q

Enchondroma: Signs and Symptoms

A

Equal distribution b/w Male and Female

Multiple Enchondromas = Ollier’s Dz

  • Marked shortening of extremities
  • Maffucci Syndrome = Ollier’s Dz + Cavernous Hemangiomatosis (looks like lots of phleboliths in hands)
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22
Q

Enchondroma: Radiographic

A

Expansile

Endosteal Scalloping - always suggests cartilaginous tumor type

No cortical breakthrough - NOT aggressive

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23
Q

Chondroblastoma

A

AKA: Codman’s Tumor.

Thin sharply demarcated sclerotic margin characteristic

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24
Q

Chondroblastoma: Signs and Symptoms

A

10-25 yoa

Joint PAIN, tenderness, heat and swelling

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25
Q

Chondroblastoma: Locations

A

Eccentric

Epiphyseal cartilage plate, extends into epiphysis; ONLY tumor that originates here.

Distal femur, proximal tibia, TUBEROSITIES or TROCHANTERS b/c they have a growth plate.

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26
Q

Chondroblastoma: DDx

A

Giant Cell; biggest difference is that the MAJORITY of these will be in metaphysis

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27
Q

Chondromyxoidfibroma

A

RARE (< 1%) benign primary neoplasm composed of chondroid, fibrous and myxoid tissues.

Male = Female, 10-30 yoa

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28
Q

Chondromyxoidfibroma: Location

A

MC proximal tibia

Metaphyseal

Eccentric oval/round

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29
Q

Chondromyxoidfibroma: Appearance

A

Radiolucent

Scalloped (cartilaginous) - thin on cortical side

Pseudo-trabeculations (soap bubble)

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30
Q

Fibrosarcoma

A

Primary malignant bone tumor that does NOT form neoplastic osteoid or cartilage

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31
Q

Fibrosarcoma: Two Types

A

Eccentric (medullary)

Periosteal

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32
Q

Fibrosarcoma: Malignant Degeneration (Secondary Cancer)

A

Fibrous Dysplasia
-MC Fibrosarcoma

Paget Dz

  • MC Osteosarcoma
  • 2nd MC Fibrosarcoma
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33
Q

Fibrosarcoma: Signs and Symptoms

A

30-50 yoa

Local pain and swelling

Hematogenous metastasis to LUNGS

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34
Q

Fibrosarcoma: Location

A

50% in KNEE

Long bones MC in young
Flat bones MC in old

Metaphysis that extends into epiphysis

35
Q

Fibrosarcoma: Radiographic

A

SEQUESTRATION

Cortical disruption + LARGE soft tissue mass common

36
Q

Fibrosarcoma: DDx

A

Giant cell - both begin in metaphysis and extend into epiphysis

37
Q

Chordoma

A

UNCOMMON primary malignant tumor arising from notochord remnants; MIDLINE tumor

38
Q

Chordoma: Signs and Symptoms

A

30-70 yoa

Constipation, urinary dysfunction, perineal pain/numbness

MAY CROSS JOINTS

Should look like a centrally destroyed sacrum/coccyx w/ calcification

39
Q

Chordoma: Location

A

MC Sacrococcygeal

40
Q

Chordoma: DDx

A

Osteomyelitis - b/c crosses joints

Giant Cell - b/c it’s the MC primary tumor of sacrum

41
Q

Giant Cell

A

QUASIMALIGNANT (begins benign but often undergoes malignant degeneration)

AKA: Osteoclastoma, GCT

42
Q

Giant Cell: Signs and Symptoms

A

Female > Male

20-40yoa (only this and ABC)

43
Q

Giant Cell: Locations

A

MC distal femur (KNEE)

MC benign tumor of SACRUM - even though out of the 4 MC painful benign tumors, it’s the LEAST likely to involve the spine

44
Q

Giant Cell: Radiographic

A

Metaphysis and WILL extend to epiphysis
Eccentric and more CIRCULAR in appearance
CLASSIC appearance - well defined margin, thin cortex, EXPANSILE, radiolucent, extends to EPIPHYSIS (subarticular surface). ***Birthday = knee, eccentric, 35yoa female w/ knee pn
About 50/50 purely LYTIC vs SOAP BUBBLE
No sclerosis

45
Q

Giant Cell: DDx

A

ABC - MC in knee; the easiest way to distinguish is pt age (GCT = 20-40; ABC = 5-20)

46
Q

Aneurysmal Bone Cyst

A

AKA: ABC

Highly EXPANSILE appearance

47
Q

Aneurysmal Bone Cyst: Signs and Symptoms

A

5-20 yoa

FEMALES > Males (only this and GCT)

48
Q

Aneurysmal Bone Cyst: Location

A

MC Femur, Tibia, T-Spine, L-Spine

MC benign tumor of CLAVICLE

49
Q

Aneurysmal Bone Cysts: Radiographic

A

Metaphyseal (can cross to epiphysis)
Eccentric and more OVAL in appearance (down long axis of bone)
KNOWN to cross an OPEN physis
EXPANSILE (very thin cortex, may not appear on plain film)
50/50 radiolucent or trabeculation (soap bubble)
BUTTRESS at EDGE of lesion is common
Fluid-fluid levels on MRI

50
Q

Hemangioma

A

MC benign tumor of spine.

Arises from newly formed blood vessels

MC type is CAVERNOUS vs capillary

51
Q

Hemangioma: Location

A

Lower T-Spine, Upper L-Spine

Frontal bone when in skull

52
Q

Hemangioma: Radiographic

A

CLASSIC appearance “Jailhouse Sign”, courduroy, vertical striations

Solitary

Sunburst or spoke-wheel in skull; will extend up out of cortex

53
Q

Hemangioma: DDx

A

Osteoporosis - b/c body eats horizontal trabecular bone first, leaving the vertical striations. Will be MULTIPLE levels

Paget Dz - lays down new bone in vertical striations. Will have cortical thickening and bone enlargement

54
Q

Simple Bone Cyst

A

AKA: SBC, unicameral bone cyst, solitary bone cyst, juvenile bone cyst

NON-PAINFUL, FLUID-filled cyst; NO chance of malignant degeneration

55
Q

Simple Bone Cyst: Two Types

A

Active - adjacent to growth plate

Latent - displaced from growth plate

56
Q

Simple Bone Cyst: Signs and Symptoms

A

3-14 yoa

Pain following trauma = lesion proximal humerus = SBC

57
Q

Simple Bone Cyst: Locations

A

Metaphysis of proximal humerus/femur

58
Q

Simple Bone Cyst: Radiographic

A

CLASSIC appearance - centrally located, truncated “ice cream cone” appearance (broad region at the metaphysis, rarely exceeds diameter of growth plate)

Fallen Fragment Sign - can be seen w/ fx, piece of bone falls into the fluid compartment and moves around with different x-ray positions

59
Q

Simple Bone Cyst: DDx

A

ABC - eccentric and PAINFUL
Giant Cell - eccentric and PAINFUL
Fibrous Dysplasia - MC neck of femur BUT older people. More stable b/c lesion is solid (not liquid). Rind Sign - looks like buttressing (sclerosing of inferior cortex)
Chondroblastoma - MC originate in EPIPHYSIS and PAINFUL
Enchondroma - Fingers
Chondromyxoid Fibroma

60
Q

Intraosseous Lipoma

A

RAREST primary benign bone tumor; ~200 cases EVER recorded

Lytic lesion

MC Tibia and Fibula

Narrow ZOT

Sclerotic border

61
Q

Synovial Sarcoma

A

ONLY PRIMARY MALIGNANT tumor in DIRECT contact w/ joint surface

30-50 yoa

MC pain and soft tissue mass at site of tumor

MC lower limbs

SOLITARY

62
Q

Paget Dz

A

AKA: Osteitis Deformans

Benign; Bone softening dz (even though it’s prolific, it’s soft bone). Precise etiology unknown; More common in Northern US, England, and Australia

50 yoa

63
Q

Paget Dz: Signs and Symptoms

A

Bone Pain - insidious

Neural compression, neuropathy (foramen closure)

Histolytic HALLMARK - Mosaic pattern

FOUR stages - determins whether it’s LYTIC or BLASTIC at the time

64
Q

Paget Dz: Signs and Symptoms - Stage 1

A

AKA osteolytic, destructive, hot, monophasic

MC skull

Lab - Increased urinary hydroxyproline d/t breakdown of collagen

BLADE OF GRASS

OSTEOPOROSIS CIRCUMSCRIPTA

65
Q

Paget Dz: Signs and Symptoms - Stage 2

A

AKA intermediate, mixed, reparative, combined, biphasic

MC Pelvis; also MC site overall
MC seen radiographically

Lab - increased alkaline phosphatase (10-20x normal) d/t excessive bone deposistion

COTTON-WOOL skull

66
Q

Paget Dz: Signs and Symptoms - Stage 3

A

AKA sclerotic, ivory, cool, inactive, quiescent

MC Pelvis, vertebra (ivory)

Lab - Increased alkaline phosphatase but much closer to normal d/t decreased bone destruction w/ continued deposition of abnormal bone

67
Q

Paget Dz: Signs and Symptoms - Stage 4

A

AKA malignant degeneration

MC Femur

OSTEOSARCOMA is the MC secondary tumor, followed by FIBROSARCOMA

60-80 yoa

If original site becomes PAINFUL = malignant degeneration. Scintigraphy should be used to DOCUMENT all original sites

68
Q

Paget Dz: Distribution

A 
MC to LC:
Pelvis/Sacrum
Femur
Skull
Tibia
Vertebra
Clavicle
Humerus
Fibula - LC overall
69
Q

Paget Dz: Radiographic

A

HALLMARKS - must say what side lesion is on (L or R)
~Cortical Thickening
~Coarsened Trabeculae - thickness increased in weight bearing lines (can resemble corduroy, hemangioma)
~Bone Enlargement
~Increased/Decreased bone density, depending on stage
Long lesion in long bones
Ward’s Triangle - in neck of femur; if OBVIOUS triangle = Paget
Ivory Vertebra
Picture Frame VB

70
Q

Paget Dz: Complications

A

Shepherd’s Crook - Coxa vera deformity of hip joint

71
Q

Fibrous Dysplasia

A

Benign; common disorder, bone undergoes physiologic resorption and replaced with woven bone in collagenous matrix.

AKA: Fibro-osseous dysplasia

2nd or 3rd Decade

72
Q

Fibrous Dysplasia: Three Forms

A

Monostotic

Polyostotic

Polyostotic w/ Endocrine Dysfunction

73
Q

Fibrous Dysplasia: Three Forms - Monostotic

A

MC, asymptomatic

MC location overall, INTERTROCHANTERIC region of proximal femur, 2nd rib

74
Q

Fibrous Dysplasia: Three Forms - Polyostotic

A

Pseudo-fractures and deformities
Larger lesions
Involvement of skull and facial bones tends to produce more sclerosis
If pelvis involved, femur usually is as well
Psuedoarthrosis
-MC lower extremity
-Neurofibromatosis and fibrous dysplasia m/c causes

75
Q

Fibrous Dysplasia: Three Forms - Polyostotic w/ Endocrine Dysfunction

A

McCune Albright Syndrome (almost exclusively precocious young females)

Triad
~Cafe-au-lait spots: Coast of Maine (jagged) = Fibrous Dysplasia, MC extraskeletal manifestation of FD. Coast of California (smooth) = Neurofibromatosis, MC extraskeletal manifestation in FIBROMA MULLOSCUM
~Polyostotic Fibrous Dysplasia
~Endocrine Dysfunction

76
Q

Fibrous Dysplasia: Location

A

Does NOT extend into epiphysis

Metaphyseal

Diaphyseal

MC benign rib lesion - common cause of EXPANSILE rib lesion; common extra-pleural sign, MC caused by Osteolytic Metastasis

77
Q

Fibrous Dysplasia: Signs and Symptoms

A

Malignant degeneration (opposite of Paget Dz)

  • MC FIBROSARCOMA
  • 2nd MC OSTEOSARCOMA
78
Q

Fibrous Dysplasia: Radiographic

A

GROUND GLASS
Rind Sign - thick sclerotic border around the lesion
Cortical THINNING - maybe intramedullary scalloping
Long lesion in long bone
PSEUDOARTHROSIS - MC caused by Fibrous Dysplasia and Neurofibromatosis
Leontiasis Ossea - “lion-like” skull

79
Q

Fibrous Dysplasia: Complications

A

Shepherd’s Crook - coxa vera deformit of hip joint

Cherubism - rounded face; “Eyes raised to heaven”

80
Q

Neurofibromatosis

A

Autosomal dominant genetic disorder that affects cell growth of neural tissue

Malignant degeneration to NEUROFIBROSARCOMA

MC of a group known as PHAKOMATOSES

81
Q

Neurofibromatosis: Two Forms

A

NF-1: aka Von Recklinghausen’s Dz

NF-2: aka Central Neurofibromatosis

82
Q

Neurofibromatosis: Two Forms - NF-1

A

AKA: Von Recklinghausen’s Dz

MC form, affects primarily peripheral nerves

Triad

  1. Cafe-au-lait spots (Coast of CA; 6+ spots considered dx)
  2. Fibroma Molluscum (soft elevated cutaneous tumors)
  3. Various osseous alterations (scoliosis etc)
83
Q

Neurofibromatosis: Two Forms - NF-2

A

AKA: Central Neurofibromatosis

Dx by the presence of bilateral acoustic schwannomas

84
Q

Neurofibromatosis: Radiographic

A

MC KYPHOSCOLIOSIS/SCOLIOSIS
Asterion Defect - virtually diagnostic
Macrocranium
Posterior Vertebral Scalloping - d/t dural ectasia (dilation)
Dumbell Neurofibroma - can erode unilateral pedicle
Multiple Non-Ossifying Fibromas

Skeletal Radiology I (4 decks)

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