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67 Cards in this Set

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Primary vs Secondary osteoporosis
Primary - senile; post-menopausal most common
Secondary - underlying dz (lots of them) such as thyrotoxicosis or renal dz (5%)
Most common/classic finding in osteoporosis
thinning of cortex esp 2nd mc mid-diaphysis
permeative vs pseudo-permeative process; what's the difference?
pseudo is cortical holes, permeative is intra medullary
Classic causes of pseudo-permeative osteoporosis...
hemangioma, dissuse osteoporosis, radiation
there are three listed
Permeative osteoporosis ddx
< 30 think Ewings Sarc, infection, EG
older think MM, mets, primary lymphoma
split the ddx into < 30 yoa vs older
Osteomalacia vs osteoporosis
malacia = enough bone just not enough mineralization ("non-mineralized osteoid")
porosis = not enough bone
Most classic cause osteomalacia
renal osteodystrophy
Radiographic differences between osteomalacia and osteoporosis
almost indistinguishable
What is the only finding pathognomonic for osteomalacia vs osteoporosis?
Looser fracture - fracture through large osteiod seams (extremely uncommon finding)
Where do Looser fractures occur?
femur, pelvis, scapula
three places
What is osteomalacia called in children?
rickets
Findings in rickets
flared and irregular epiphysis, bending of long bones,
Most common cause of rickets in children?
As in adults it is renal (renal osteodystrophy)
What does excess PTH cause in bone?
osteoclastic resorption; osteoporosis AND osteomalacia
What is primary hyperparathyriodism (HPT) caused by?
parathyriod adenomas and hyperplasia.
Primary vs Secondary osteoporosis
Primary - senile; post-menopausal most common
Secondary - underlying dz (lots of them) such as thyrotoxicosis or renal dz (5%)
Most common/classic finding in osteoporosis
thinning of cortex esp 2nd mc mid-diaphysis
permeative vs pseudo-permeative process; what's the difference?
pseudo is cortical holes, permeative is intra medullary
Classic causes of pseudo-permeative osteoporosis...
hemangioma, dissuse osteoporosis, radiation
there are three listed
Permeative osteoporosis ddx
< 30 think Ewings Sarc, infection, EG
older think MM, mets, primary lymphoma
split the ddx into < 30 yoa vs older
Osteomalacia vs osteoporosis
malacia = enough bone just not enough mineralization ("non-mineralized osteoid")
porosis = not enough bone
Most classic cause osteomalacia
renal osteodystrophy
Radiographic differences between osteomalacia and osteoporosis
almost indistinguishable
What is the only finding pathognomonic for osteomalacia vs osteoporosis?
Looser fracture - fracture through large osteiod seams (extremely uncommon finding)
Where do Looser fractures occur?
femur, pelvis, scapula
three places
What is osteomalacia called in children?
rickets
Findings in rickets
flared and irregular epiphysis, bending of long bones,
Most common cause of rickets in children?
As in adults it is renal (renal osteodystrophy)
What does excess PTH cause in bone?
osteoclastic resorption; osteoporosis AND osteomalacia
What is primary hyperparathyriodism (HPT) caused by?
parathyriod adenomas and hyperplasia.
What percentage of patients with primary HPT will get bone findings?
40%
Secondary HPT cause?
Most commonly renal...secret PTH in response to decreased Ca++
Pathognomonic radiographic finding in HPT?
Subperiosteal bone resorption
Where is sub-periosteal bone resorption in HPT most commonly seen?
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
one classic, three others
What is another radiographic finding in HPT?
osteosclerosis, diffuse
Where is osteosclerosis classically seen in HPT?
spine "rugby jersey" or "rugger jersey spine"
What is a classic lesion seen in HPT?
Brown tumors
What is the only unique characteristic of a brown tumor?
it's association with subperiosteal bone resorption. It looks cystic, expansile and aggressive but can have a variety of appearances.
what is a description of brown tumor?
What radiograph or radiographs are recommended in HPT?
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.
What radiographic findings are there in hypoparathyriodism?
Few...calvaria on occasion show thickining; calcification of basal ganglia.
What characteristic appearance is there in pseudohypoparathyriodism and pseudopseudohyperparathyroidism?
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
Gigantism vs acromegaly difference
G occurs before physis close...both are 2/2 hypersecreting adenomas or hyperplasia of the pituitary.
Radiographic findings in acromegaly
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
In children what can result from thyrotoxicosis?
increased skeletal maturation, seldom
has to do with skeletal development
How about thyrotoxicosis in adults...what can you find?
thyroid achropachy...rare though
How can you tell thyroid achropachy from other causes of diffuse periostitis?
In thryotoxicosis it invariably involves ulnar aspect of the fifth mc. It is a characteristic periostitis involving the hands and feet.
Other causes of achropachy...
(aka osteoarthropathy) hypertrophic pulmonary osteoarthropathy and pachydermoperiostitis (rare form of idiopathic periostitis and skin thickening)
two examples
Decreased thyroid secretion also called?
cretinism
Cretinism skeletal findings?
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.
Osteosclerosis definition
diffuse increased bone density...every radiologist needs a ddx for this...fortunatly this is short.
DDx osteosclerosis and mnemonic
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"
Most common dz causing osteosclerosis?
renal osteodystrophy causing HPT...10-20% show osteosclerosis (most common finding osteopenia)
Findings in sickle cell dz (bone)?
osteosclerosis (small percentage), fish vertebrae, avn hip, bone infarcts
4 findings
Whenever osteosclerosis is seen in someone greater than 50 years what should be looked for?
splenomegaly, extramedullary hematopoisis
myelofibrosis findings secondary to progressive fibrosis of marrow.
Classic findings in osteopetrosis
bone in bone apperance and sandwich vertebrae
two
osteopetrosis...two types
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.
pyknodysostosis info
congenital, more rare than osteopetrosis
findings pyknodysostosis
short stature, hypoplastic mandible, acroosteolysis with sclerosis (chalk appearing distal phalanges in pencil sharpener) is pathognomonic
another name of pyknodysostosis
Toulouse-Lautrec syndrome (famous French painter)
Metastatic carcinoma types that typically cause osteosclerosis
prostate or breast...overall rare that these mimic diffuse osteosclerosis
Mastocytosis classic findings
thickened small bowel folds, diffuse osteosclerosis (non-specific), urticaria pigmentosa....this is a rare disorder
one non-radiographic
Paget Dz classic findings
bony enlargement (not always present but classic) most commonly in pelvis most commonly iliopectineal line must be thickened...can occur in any bone though
one finding
three phases of Paget's
lytic, sclerotic, mixed lytic-sclerotic
common terms used to describe lytic phase of Paget's
flame-shaped lytic lesion or blade of grass leading edge
lytic lesion of Paget's has one criteria that must be present
start at end of bone (with sole exception of tibia). can exclude pagets if this is not a characteristic.
Flourosis (rare) causes
flouride in drinking water or tx with sodium flouride for osteoporosis
Osteosclerosis in flourosis classic finding
ligamentous calcification (most classic sacrotuberous)