Vascular conditions and neuropathic arthropathy Flashcards
What are HAEMANGIOMAS?
Greek: Haem = Blood ; Angeio = Vessel; -oma = tumour
A benign and usually self-limiting tumour of the endothelial cells that line blood vessels
Characterised by increased number of normal or abnormal vessels filled with blood – blood vessels forming a birthmark
Congenital or traumatic
Vertebral Haemangiomas:
- Atypical haemangiomas
- lower fat content
- most common benign vertebral neoplasms – NOT true neoplasms but venous malformations
- Usually, asymptomatic - symptomatic in the 4thdecade of life.
- Incidentally detected on routine radiographs of the spine
- Rarely, locally aggressive
- Slightly more in females than men - Two main types:
- Cavernous (involves relatively large vessels)
- Capillary (involves small capillaries) angiomas
Vertebral Haemangiomas:
- Clinical Findings
- PAIN – due to:
- collapsed vertebral body or encroachment into the neural canal
- An increase in activity e.g starting to exercise, housework
- axial loading through the body of the vertebra.
- Displacement of the bone due to vascular spacing
- M/C in thoracic spine but can be found throughout the spine.
What is ATHEROSCLEROSIS?
AKA “Hardening of the arteries” where the arterial walls thicken due to build up of fatty materials e.g., cholesterol
Preventable and treatable
CAUSED BY:
- High blood pressure
- High cholesterol
- An irritant e.g., nicotine
- Certain diseases e.g., diabetes
- formation of multiple plaques within the arteries, resulting in:
- Obstruction (restricting blood flow)
- thrombus formation (causing blood clot)
- aneurysmal dilation
What are the clinical findings of ATHEROSCLEROSIS?
- Develops gradually (typically begins in early adolescence)
- Usually found in most major arteries inc.:
- Aorta
- Iliac arteries
- Subclavian
- Carotid
- Coronary
- Femoral
What are the radiological findings of ATHEROSCLEROSIS?
- Radiographic evidence depends on the presence of calcification
- Incidence of calcification increases with age and is seen in about 40% of patients over the age of 45
- Unusual if seen below the age of 40 and suggest possible undiagnosed Hypertension (HTN) or diabetes mellitus (DM)
- Degree of calcification DOES NOT correlate with the degree of luminal narrowing
What are the two main types of Vertebral Haemangiomas?
- Cavernous (involves relatively large vessels)
- Capillary (involves small capillaries) angiomas
What are the complications of ATHEROSCLEROSIS?
- Coronary Artery Disease
- Narrowing of arteries close to heart, causing chest pain (angina) or heart attack2. Carotid Artery Disease - Narrowing of arteries close to brain, causing transient ischemic attack (TIA) or stroke 3. Peripheral Artery Disease - Narrowing of arteries in arms or legs, causing circulation problems e.g. less sensitive to heat and cold and in more severe cases poor circulation causes tissue death (e.g. gangrene) 4. Aneurysms - A serious complication due to a bulge in the wall of the artery which if bursts can cause life threatening internal bleeding
What is ABDOMINAL AORTIC ANEURYSM (AAA)?
Most commonly seen atherosclerotic vessel
Should measure less than 3.8cm in it’s AP dimension
Calcification is generally seen anterior to the L3 and L4 levels (i.e. just above bifurcation level)
What is the EPIDEMIOLOGY of ABDOMINAL AORTIC ANEURYSM (AAA)?
- AAA present in 2-4% of the population > 50
- Male > female
- 10,000 deaths/yr – 12th leading cause of death in Western society
- Silent Killer – no symptoms to indicate an aneurysm is developing in the abdominal aorta
- Rupture has a > 80% mortality rate
What are the signs and symptoms of ABDOMINAL AORTIC ANEURYSM (AAA)?
- Abdominal/back/flank pain (L>R)
- Testicular or leg pain
- Stable vital signs
What are the risk factors of ABDOMINAL AORTIC ANEURYSM (AAA)?
- Cardiovascular disease
- Family History increases risk 10-20%
- Age > 50
- Smoker
What is the RATE OF EXPANSION VARIABLE in AAA?
- 4-4.9 cm AAA - 3.3% risk of rupture
- 5cm AAA - 14% risk of rupture
- > 5cm - 20-40% risk of rupture
What is COMMON ILIAC ARTERYANEURYSM?
Second most common site for an aneurysm
Typically fusiform
Overlying the sacroiliac joint on the AP and generally seen as a ring-like density anterior to approximately L5 or slightly more inferior
Second most common vessels to calcify
Generally seen at or slightly below the bifurcation, anterior to the L5 level and often seen on end as a circular or ring like density
If seen on AP projection, will be seen as linear, parallel densities oriented inferior and lateral passing into the pelvic basin near the inferior sacroiliac joint
May see calcification of internal and external branches.
What is VERTEBRAL ARTERYANEURYSM?
Uncommon
Most frequently seen at the C1/2 level
Dilation may result in an erosive defect visible adjacent to the C2 pedicle and transverse process**
Course of normal vertebral artery. (VA)Zones:V1 = before the artery enters the C6 transverse foramen .V2 =within transverse foramen (C6 to C2)V3 = from C2 transverse foramen but before entry into the dura.V4 = after entry into dura.Aneurysn of the VA can occur along its course causing a pressure erosion of a vertebra – usually a slow process.
What is FEMORAL ARTERY CALCIFICATION ?
Superimposed over the femoral head and branches seen medial to the femoral neck at times
What is SPLENIC ARTERY CALCIFICATION?
Third most common vessel to calcify
Tortuous, serpiginous (snake-like) calcification in the left upper quadrant, outside the splenic shadow and at approximately the L2 level
What is CAROTID ARTERY CALCIFICATION?
Most commonly visible at the bifurcation, below the mandible and lateral to the c/s at about the C3 or C4 levels
Note: subtle calcific densities in the soft tissues lateral to cervical vertebral structures.
What is SICKLE CELL ANAEMIA?
Hereditary disorder of abnormal blood cell shape
Abnormal molecular structure of hemoglobin
- When under low pressure, RB’s distort and become sickle shaped
+/- clinical S/S or radiographic findings
Homozygous (HbS-S) is usually symptomatic, other types (HbS-A and HbS-Thal) usually clinically silent
What are the clinical findings of sickle cell anaemia?
- Onset after 6 months when change from fetal Hb to adult form
- Weakness and pallor
- Jaundice
- Episodic abdominal crisis
- Acute bone pain
- Dactylitis
- Predisposed to salmonella infection (?)
What are the Radiological Findings of sickle cell anaemia?
- Long bones
- Osteopenia, Large vascular channels, Undertubulation (wide medullary cavity; Erlenmeyer flask)- Skull
- Wide diploic space, Granular appearance or “Hair on end”
- Spine
- Osteoporosis, Endplate deformities (central part of endplate involved) of several contiguous vertebra– “H shaped vertebral bodies”
- Others
- Prone to infarcts
- Skull
What is NEUROPATHIC ARTHROPATHY?
AKA “Charcot Joint”
A progressive condition of the MSK system, characterised by:
- Joint dislocations
- Pathologic fractures
- Debilitating deformities
What is SYNOVIOCHONDROMETAPLACIA?
AKA “Synovial Chondromatosis” or “osteochondromatosis”
A rare benign condition characterised by the presence of cartilaginous nodules in the synovium of the joints, tendon sheaths and bursae which often occur without trauma or inflammation.
Disease progression leads to loose bodies ossifying, forming a density that may be visualized on radiographs.
Secondary form may be present after long standing OA, trauma or infection
Epidemiology:
- Males > Females (2:1)
- 20 – 40 years
Aetiology:
- Primary – Unknown
- Secondary – M/C
- occurs in pre-existent OA, RA, Osteonecrosis, Infection or Trauma
What is the pathophysiology of SYNOVIOCHONDROMETAPLACIA?
- Benign process associated with extremely low risks of malignancy
- Typically monoarticular, affecting large joints inc
- Knee – M/C (60-70%)
- Shoulder
- Elbow
- Hip
What are the signs and symptoms of SYNOVIOCHONDROMETAPLACIA?
- Monoarticular Pain and stiffness
- Decreased ROM
- Effusions
- Crepitation
- Joint locking
What are the radiological findings for SYNOVIOCHONDROMETAPLACIA?
Radiological Findings:
1. Plain radiographs
- may be normal depending on the stage of disease and the extent of calcification or ossification of the cartilaginous nodules
- General Findings:
- Multiple small, well-defined, juxta-articular nodules of uniform size
- soft-tissue mass surrounding the joint
- joint space widening
- erosions of adjacent bones
- early osteoarthritic changes
- Ring arch calcification
2. MRI
- variable and depends on loose bodies formation and extent of calcification or ossification.
- Typical chondroid signal characteristics:
- T1:intermediate to low signal
- T2:high signal
- Focal areas of signal void within these nodules represent areas of mineralisation
What are the anatomical classifications of NEUROPATHIC ARTHROPATHY?
1 - forefoot 10-30%
2 - Lisfranc’s joint (most common)
3 - midtarsal joint, often including naviculocunieform joint
4 - ankle and subtalar joints 8-10%
5 - posterior pillar fracture of calcaneus 2%
What are the 6 d’s in NEUROPATHIC ARTHROPATHY?
Dense bones
Degeneration
Destruction
Deformity
Debris
Dislocation
