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67 Cards in this Set
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Primary vs Secondary osteoporosis
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Primary - senile; post-menopausal most common
Secondary - underlying dz (lots of them) such as thyrotoxicosis or renal dz (5%) |
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Most common/classic finding in osteoporosis
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thinning of cortex esp 2nd mc mid-diaphysis
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permeative vs pseudo-permeative process; what's the difference?
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pseudo is cortical holes, permeative is intra medullary
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Classic causes of pseudo-permeative osteoporosis...
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hemangioma, dissuse osteoporosis, radiation
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there are three listed
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Permeative osteoporosis ddx
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< 30 think Ewings Sarc, infection, EG
older think MM, mets, primary lymphoma |
split the ddx into < 30 yoa vs older
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Osteomalacia vs osteoporosis
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malacia = enough bone just not enough mineralization ("non-mineralized osteoid")
porosis = not enough bone |
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Most classic cause osteomalacia
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renal osteodystrophy
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Radiographic differences between osteomalacia and osteoporosis
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almost indistinguishable
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What is the only finding pathognomonic for osteomalacia vs osteoporosis?
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Looser fracture - fracture through large osteiod seams (extremely uncommon finding)
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Where do Looser fractures occur?
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femur, pelvis, scapula
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three places
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What is osteomalacia called in children?
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rickets
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Findings in rickets
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flared and irregular epiphysis, bending of long bones,
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Most common cause of rickets in children?
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As in adults it is renal (renal osteodystrophy)
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What does excess PTH cause in bone?
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osteoclastic resorption; osteoporosis AND osteomalacia
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What is primary hyperparathyriodism (HPT) caused by?
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parathyriod adenomas and hyperplasia.
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Primary vs Secondary osteoporosis
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Primary - senile; post-menopausal most common
Secondary - underlying dz (lots of them) such as thyrotoxicosis or renal dz (5%) |
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Most common/classic finding in osteoporosis
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thinning of cortex esp 2nd mc mid-diaphysis
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permeative vs pseudo-permeative process; what's the difference?
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pseudo is cortical holes, permeative is intra medullary
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Classic causes of pseudo-permeative osteoporosis...
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hemangioma, dissuse osteoporosis, radiation
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there are three listed
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Permeative osteoporosis ddx
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< 30 think Ewings Sarc, infection, EG
older think MM, mets, primary lymphoma |
split the ddx into < 30 yoa vs older
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Osteomalacia vs osteoporosis
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malacia = enough bone just not enough mineralization ("non-mineralized osteoid")
porosis = not enough bone |
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Most classic cause osteomalacia
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renal osteodystrophy
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Radiographic differences between osteomalacia and osteoporosis
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almost indistinguishable
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What is the only finding pathognomonic for osteomalacia vs osteoporosis?
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Looser fracture - fracture through large osteiod seams (extremely uncommon finding)
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Where do Looser fractures occur?
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femur, pelvis, scapula
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three places
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What is osteomalacia called in children?
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rickets
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Findings in rickets
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flared and irregular epiphysis, bending of long bones,
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Most common cause of rickets in children?
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As in adults it is renal (renal osteodystrophy)
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What does excess PTH cause in bone?
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osteoclastic resorption; osteoporosis AND osteomalacia
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What is primary hyperparathyriodism (HPT) caused by?
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parathyriod adenomas and hyperplasia.
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What percentage of patients with primary HPT will get bone findings?
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40%
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Secondary HPT cause?
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Most commonly renal...secret PTH in response to decreased Ca++
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Pathognomonic radiographic finding in HPT?
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Subperiosteal bone resorption
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Where is sub-periosteal bone resorption in HPT most commonly seen?
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radial aspect of middle phalanges of hand; however can be seen in any long bone in body...commonly on medial aspect of prox tibia, at SI joints, and distal clavicles
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one classic, three others
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What is another radiographic finding in HPT?
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osteosclerosis, diffuse
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Where is osteosclerosis classically seen in HPT?
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spine "rugby jersey" or "rugger jersey spine"
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What is a classic lesion seen in HPT?
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Brown tumors
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What is the only unique characteristic of a brown tumor?
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it's association with subperiosteal bone resorption. It looks cystic, expansile and aggressive but can have a variety of appearances.
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what is a description of brown tumor?
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What radiograph or radiographs are recommended in HPT?
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plain film of hands to look for supperiosteal bone resorption....metabolic bone surveys (hands, spine and long bones) no longer rec. NM scan can also be added to look for increased uptake in brown tumors and Looser fractures.
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What radiographic findings are there in hypoparathyriodism?
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Few...calvaria on occasion show thickining; calcification of basal ganglia.
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What characteristic appearance is there in pseudohypoparathyriodism and pseudopseudohyperparathyroidism?
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aside: pseudohyperparathyroidism is an end organ dz..not lack of PTH. pseudopseudo is neither...pt's just look like pseudo. answer: obesity/ round facies, short stature/ brachydactyly (short digits), tubular bones
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Gigantism vs acromegaly difference
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G occurs before physis close...both are 2/2 hypersecreting adenomas or hyperplasia of the pituitary.
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Radiographic findings in acromegaly
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1. calvarial thickening almost always, 2. enlarged sinuses,
3. enlarged sella, 4. prognathic jaw, 5. terminal tufts hypertrophied with spade appearance, 6. joint spaces occasionally enlarged 2/2 hyaline cartilage enlargement, 7. early DJD, 8. soft tissue enlargement (heel pad). |
8 findings
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In children what can result from thyrotoxicosis?
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increased skeletal maturation, seldom
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has to do with skeletal development
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How about thyrotoxicosis in adults...what can you find?
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thyroid achropachy...rare though
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How can you tell thyroid achropachy from other causes of diffuse periostitis?
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In thryotoxicosis it invariably involves ulnar aspect of the fifth mc. It is a characteristic periostitis involving the hands and feet.
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Other causes of achropachy...
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(aka osteoarthropathy) hypertrophic pulmonary osteoarthropathy and pachydermoperiostitis (rare form of idiopathic periostitis and skin thickening)
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two examples
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Decreased thyroid secretion also called?
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cretinism
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Cretinism skeletal findings?
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delayed skeletal maturation in children: delay in ossification of epiphysial centers with occasional appearance of stippled epiphysis, delay in closure of physis, in some instances into third and fourth decade of life.
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Osteosclerosis definition
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diffuse increased bone density...every radiologist needs a ddx for this...fortunatly this is short.
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DDx osteosclerosis and mnemonic
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1. renal osteodystrophy
2. sickle 3. myelofibrosis 4. osteopetrosis 5. pyknodysostosis 6. metastatic carcinoma 7. mastocytosis 8. Paget dz 9. athletes 10. flourosis "Regular sex makes occasional perversions much more pleasurable and fantastic" |
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Most common dz causing osteosclerosis?
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renal osteodystrophy causing HPT...10-20% show osteosclerosis (most common finding osteopenia)
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Findings in sickle cell dz (bone)?
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osteosclerosis (small percentage), fish vertebrae, avn hip, bone infarcts
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4 findings
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Whenever osteosclerosis is seen in someone greater than 50 years what should be looked for?
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splenomegaly, extramedullary hematopoisis
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myelofibrosis findings secondary to progressive fibrosis of marrow.
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Classic findings in osteopetrosis
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bone in bone apperance and sandwich vertebrae
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two
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osteopetrosis...two types
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congenital and tarda. both have different degrees of severity. congenital seen at birth and can be lethal. see anemia, jaundice, hepatosplenomegaly and infections. tarda seen in older children and adults and can be really mild...fairly rare.
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pyknodysostosis info
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congenital, more rare than osteopetrosis
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findings pyknodysostosis
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short stature, hypoplastic mandible, acroosteolysis with sclerosis (chalk appearing distal phalanges in pencil sharpener) is pathognomonic
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another name of pyknodysostosis
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Toulouse-Lautrec syndrome (famous French painter)
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Metastatic carcinoma types that typically cause osteosclerosis
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prostate or breast...overall rare that these mimic diffuse osteosclerosis
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Mastocytosis classic findings
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thickened small bowel folds, diffuse osteosclerosis (non-specific), urticaria pigmentosa....this is a rare disorder
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one non-radiographic
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Paget Dz classic findings
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bony enlargement (not always present but classic) most commonly in pelvis most commonly iliopectineal line must be thickened...can occur in any bone though
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one finding
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three phases of Paget's
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lytic, sclerotic, mixed lytic-sclerotic
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common terms used to describe lytic phase of Paget's
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flame-shaped lytic lesion or blade of grass leading edge
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lytic lesion of Paget's has one criteria that must be present
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start at end of bone (with sole exception of tibia). can exclude pagets if this is not a characteristic.
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Flourosis (rare) causes
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flouride in drinking water or tx with sodium flouride for osteoporosis
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Osteosclerosis in flourosis classic finding
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ligamentous calcification (most classic sacrotuberous)
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