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129 Cards in this Set
- Front
- Back
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FEGNOMASHIC stands for?
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Fibrous Dysplasia
Enchondroma/EG Giant Cell tumor Nonossifying Fibroma Osteoblastoma Metastatic Disease/Myeloma Aneurysmal Bone cyst Solitcary Bone Cyst Hyperparathyroidism Infection Chondroblastoma |
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Fibrous Dysplasia - Hallmarks
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GG matrix
No periosteal reaction |
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Fibrous dysplasia, distribution?
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Pelvis
Proximal femur Ribs(typically expansile, lytic appearance in posterior ribs) Skull |
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When a lesion is encountered in the tibia that resembles fibrous dysplasia, what esle should be mentioned?
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Adamantinoma, occurs almost exclusively in the tibia and jaw(p983 fig 40.6)
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Cherubism?
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Multiple lesions of fibrous dysplasia in the jaw
physical appearance of a child with puffed out cheeks the lesions in jaw regress in adulthood |
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McCune Albright Syndrome
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Polyostotic fibrous dysplasia
cafe au lait spots Precocious Puberty |
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Most common benign cystic lesion in the phalanges?
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Enchondroma -
phalanges are the only location in the skeleton that does not contain a calcified chondroid matrix |
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Enchondromas - Discriminators?
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1. Must have a calcified Matrix(except phalanges)
2. No periostitis or pain |
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EG discriminator?
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Age less than 30.
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Ddx for lesions with a bony sequestrum.
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EG
Osteomyelitis Lymphoma Fibrosarcoma Osteoid Osteoma - when sequestrum partially calcified |
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Giant cell tumor (4 criteria)
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1. Only when epiphyses closed
2. Abuts Articular Surface 3. Eccentrically located 4. Well defined zone of transition that is not sclerotic |
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NOF is also knrown as?
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Fibrous cortical defect(< 2 cm)
(>2cm, NOF) |
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NOF - Discriminators
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1. Younger than 30
2. No periostitis or pain (large benign cortical defect) |
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Osteoblastoma - features
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Rare bone tumor
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Osteoblastomas look like?
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Large osteoid osteomas and are often called giant osteoid osteomas
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Osteoblastomas most commonly occur in?
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Posterior elements of the vertebral bodies
- half demonstrate speckled calcifications |
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Classic Ddx for an expansile lytic lesion in the posterior elements of the spine?
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Osteoblastoma
ABC(may have fluid fluid level) TB |
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In general the lytic expansile metastatis lesions are from?
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Thyroid
Renal cell Remember Plasmacytoma |
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The only metastatic lesion that is always e lytic is?
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RCC
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ABC discriminators
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Must be expansile
Less than 30 years old |
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ABC on cross sectional studies CT and MR?
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fluid fluid levels
telangiectatic osteosarcomas also have fluid fluid levels |
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Solitorary bone cyst is the only lesion in FEGNOMASHIC that is?
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Always central in location
Many other lesions may be central, but a solitary bone cyst can be excluded if it isn't. |
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Where do 2/3 to 3/4 of these lesions occur?
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In the proximaly humerus and proximal femur
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A classic radiographic finding for a solitary bone cyst is?
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Fallen fragment sign - occurs when a piece of cortex breaks off after a fracture in a solitary bone cyst, and a piece of cortical bone sinks to the gravity-dependent portion of the lesion, indicates a fluid filled cystic lesion rather than a lesion filled with matrix
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Solitary bone cyst Discriminators
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Must be central
Must be less than 30 No periostitis |
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What is pathognomonic for HPT?
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Subperiosteal bone resorption
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Where is classic location for subperiosteal bone resporption for HPT?
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Terminal tufts
Middle phalanges(particularly the radial aspect of the middle phalanges) Distal clavicle(resorption, also RA) Medial aspect of the tibia Pelvis - SI joints(widening), pubic symphysis |
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Chondroblastoma lesions only occur in?
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The epiphyses.
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Ddx of a lytic lesion in the epiphysis of a patient less than 30.(3)
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Infection(most common)
Chrondroblastoma Giant cell tumor always consider possibility of subchondral cyst or geode |
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Subchondral cyst or geode - Disease processes
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DJD
RA CPPD or pseudogout Avascular necrosis |
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Chondroblastoma discriminators
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Must be less than 30 years old
Must be epiphyseal |
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What lesion is Chondromyxoid fibroma like?
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NOF
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Discriminators of Chondchondromyxoid fibromas from NOF.
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they often extend into the epiphyses, whereas NOFs rarely do
- can present with pain(rare in NOF - no calcified cartilage matrix |
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Chondchondromyxoid fibromas discriminators
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1. Mention when NOF is mentioned
2. No calcied matrix |
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Lesions in patients < 30.
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EG
ABC NOF SBC(Solitary bone cyst) Chondroblastoma |
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Automatics regardless of location or appearance
(age < 30 or >30) |
Younger than 30
Infection EG Older than 40 Infection Mets/Myeloma |
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Lesions with no pain or periostitis(4)
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Fibrous dysplasia
Enchondroma NOF Solitary bone cyst |
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Epiphyseal lesions(4)
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Infection
Giant cell tumor Chondromblastoma Geode(Subchondral cysts) |
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DDx for rib lesions(FAME)
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Fibrous Dysplasia
ABC Mets/Myeloma Enchondroma/EG |
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DDx for multiple lesions(FEEMHI)
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Fibrus dysplasia
EG Enchondroma Mets/Myeloma HyperPTH Infection |
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What are considered epiphyseal equivalents?
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Tarsal bones(especially calcaneous)
Apophyses Carpal bones Patella |
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Lesion with a sclerotic focus in a 20-40 year old patient, especially if it in an asymptomatic patient.
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NOF
EG ABC SBC Chondroblastoma |
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What genetic disorder gets multiple NOFs?
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NF
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DDx for chondroid matrix(p 1067) old B and H
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Enchondroma
Chondrosarcoma Infarcts(Serpigenous) |
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What syndromes have multiple osteochondromas?
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Ollier's disease
Maffucci's |
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The presensce of multiple enchondromas associated with soft tissue hemangiomas is also known as?
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Malfucci Syndrome
(calcifications make it hemangiomas) |
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Ollier's vs Maffucis (malignant potential)
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Ollier - no increased rate of malignant degeneration
Maffuccis - increased rate of malignant degeneration |
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What processes causes subchondral cysts or geodes(p 1081 old b and h)
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DJD
CPPD RA AVN Hemophilia PVNS |
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DDx for aggresive lesion(periostitis, wide zone)
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Infection
Malignancy EG |
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DDX malignancy based on age(1-30, 30-40, >40)
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1-30
Ewing Osteosarcoma Neuroblastoma 30-40 Giant Cell Sarcoma Lymphoma >40 Mets/Myeloma |
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What's the most common primary bone tumor?
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Osteosarcoma
at the end of of long bones less than 30 years old |
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Telangiectatic type osteosarcoma features?
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Fluid fluid levels
(also consider ABC and MFH with fluid fluid levels) |
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Factors that cause osteosarcoma at age greater than 30?
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XRT
Paget's - sarcomatous degeneration |
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Describe classic Ewing's.
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In diaphysis
< 30 permeative "onion skin" |
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What distinguishes chondrosacoma, enchondroma or exostosis?
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pain,
destruction and periostitis(p1008) |
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Classic Sclerotic bone Mets?
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1. Prostate
2. Breast 3. Lung 4. Bowel |
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What are the two most common ST tumors?
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Malignant Fibrous Histiocytoma(formerly Fibrosarcoma)
Liposarcoma |
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Ddx for Focal cortical thickening.
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Infection
Stress Fracture Osteoid Osteoma |
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Posterior Knee lesions(p1005-1006)
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Parosteal Osteosarcoma
Cortical Desmoid - avulsion injury Myositis ossificans - post trauma |
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PVNS on MRI
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Low T1
Low T2 Like hemosiderin, erosions, calcs |
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What cancers metastasize to bone?
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BLT with Kosher Pickle?
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Normal Atlanto-dens interval?
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Children - up to 5 mm.
Adults - 2.5 mm- greater than that think disruption of transverse ligament. |
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What dz processes have a big Atlanto-dens interval?
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Downs
RA |
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Jefferson fracture?
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Break in ring of C1, 2 spots, axial load injury
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Hangman's fracture
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C2 posterior elements, hyperextension injury.
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Gamekeeper's Thumb?
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Fracture on the ulnar side of the 1sr MCP
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Steiner lesion
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adduct aponeurosis under the avulsed ligament, yo-yo sign
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Classic differential diagnosis for a permeativ lesion in a child is?
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Ewing sarcoma
Infection EG |
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When you get a lunate dislocation what syndrome can you get acutely?
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Acute carpal tunnel from compressing median nerve
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Bennett/Rolando fracture?
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Base of the 1st MCP.
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Multiple calcific loose bodies think?
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Synovial Osteochondromatosis
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What should you be careful about with any anterior wedging injury to a vertebral body?
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Should have the posterior elements of that level closely inspected.
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Kummell's disease?
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A wedge compression fracture in trauma and if left unprotected can proceed to delayed further collapse with resulting severe neurologic deficits(paraplegia(1023)
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Mallet finger?
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Avulsion injury at the base of the distal phalanx where the extensor digitorum inserts
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"Terry Thomas" sign p 1028 figure 42.27)
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Gave or space between the navicular(scaphoid) and the lunate
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OA (three features)
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joint space narrowing
Osteophytes Sclerosis |
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DISH elements
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At least 4 levels
Disck space maintained a/w ossification of the posterior longitudinal ligament enthesophytes(pelvis) |
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Erosive osteoarthritis distribution?
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DIP
PIP 1st CMC "Gull Wing" ddx looks like psoriatic arthritis same distribution as OA |
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Hallmarks of RA
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ST swelling
Marginal erosions(proximal, carpal, MCP) Low bone mineral density |
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Differential for high riding humerous
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Chronic rotator cuff tear
RA CPPD |
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Bilateral SI Joint disease(4)
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Symmetric
Ank Spond IBD Asymmetric Psoriatic Arthritis Reiter's |
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Psoriatic arthritis, features
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Fluffy periostitis
mickey mouse ears - prolif erosions, pencil in cup |
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Gout features
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ST swelling, can calcify(renal disease also can)
Bony erosions - well marginated rat bite erosion) No osteoperosis |
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Typical CPPD locations(4)
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Elbow
Shoulder Radiocarpal TFC Patellofemoral-meniscus MCP |
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Processes a/w CPPD?
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Gout
Primary HyperPTH Hemochromotosis - Primary pseudo-charcot(CPPD) |
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Wha5t processes are associated with calcium hydroxyappetite?
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1. Calcific tendinitis
2. Milwaukee Shoulder - Get blood effusions |
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Charcot joint 4 Ds
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Dislocation
Destruction Debris Distension |
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Charcot knee think?
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Sphillis
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Charcot spine think?
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Syphyllis
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Charcot shoulder think?
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Syrinx
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What processes cause enlarged epiphysesis(overgrowth of ends of long bones)?
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1. JRA
2. RA 3. Paralysis(from disuse) |
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What has been termed giant cell tumor of tendon sheath?
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PVNS
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Why is PVNS characteristically low on T1 and T2?
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Old blood products
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Sudeck atrophy is also knowing as (p 1060)
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Shoulder hand syndrome
Reflex Sympathetic dystrophy Chronic regional pain syndrome (patchy juxta-articular osteoperosis) |
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Findings of AVN?
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Effusion
Sclerosis Subchondral lucency Articular collapse (Findings on one side of the joint) |
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Form of AVN that is smaller and more focal than that is called?
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Osteochondritis dissecans
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Locations of osteochondritis dessicans?
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1. Lateral aspect of the medial condyle in the knee
2. Medial aspect of Talar dome 3. Elbow - capitellum frequently leads to a small fragment of bone being sloughed off and becoming a free fragment or joint mice |
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Classic radiographic changes of hemochromotosis?
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Essentially DJD, which involves the second through the fourth MCP joints.
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What is Kienbock Malacia?
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Avascular necrosis of the lunate.
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Freiberg infarction?
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Flattening, collalapse and sclerosis of the second metatarsal head
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Scheuermann Disease
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Avascular necrosis of the apophyseal rings of the vertebral bodies
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Differential diagnosis of cortical holes, pseudopermeative lesions?
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Hemangioma
XRT Osteoperosis |
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Number 1 cause of osteomalacia?
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Renal disease
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Osteomalacia in kids?
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Rickett's
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What is pathognomic of Osteomalacia?
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Looser fractuesTranvserse fractures
femur, pelvis, scapula |
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What distinguishes primary from secondary hyperparathyroidism?
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Primary - adenoma > hyperplasia, high ca, low ph
Secondary - low ca, therefor elevatated PTH Tertiary - autonomous fx from longstanding low Ca |
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What is pathonomonic of hyperPTH?
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Subperiosteal bone resorption
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What clue might you get for hyperPTH?
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Clips in wrist - fistula tract
lytic on film |
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Hand finding of pseudo and pseudo PTH?
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Shorth Metacarpals - also seen in Turner's or other chromosomal abnormalities
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What is thyroid acropatchy?
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charcteristic periostisis occurs in metacarpals and phalanges of hands and feet(invariable ulnar aspect of 5th metacarpal
Rare manifestation of hyperthyroidism This occurs after thyroidectomy |
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Otosclerosis
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Regular Sex
Renal osteodystrophy SS DX Myelofibrosis Osteopetrosis Pyknodysostosis Mets Mastocytosis Paget's Athletes Fluorosis |
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Rugger Jersey spine p 1071 44.13)
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Sclerotic bands present at the ventebral body end plates chararacteristic of hyperPTH
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SS features
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Bone infarcts
Fish spine Log vertebral bodies AVN |
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Clue for myelofibrosis
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Splenomegaly
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Osteopetrosis findings p 1074-75)
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Congenital and Tarda forms
So called bone-in-bone appearance often seen in the vertebral bodies |
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Pyknodysostosis also known as
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Toulouse-Lautrec syndrome
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What finding do you get Pyknodysostosis(pathonogmonic finding)
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acroosteolysis with sclerosis
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Mastoctosis - clue?
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Skin finding, Erticaria Pigmentosa
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Features of Paget's
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Thickened Cortex, coarse trabeculation
Bony enlargement Lytic,blastic - blade of grass/flame Increased AP |
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Flourosis - finding that can be a/w it?
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ligamentous calcification
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Classic calcification pattern of myositis Ossificans
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central lucency and peripheral calcifications
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Cortical desmoid?
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process on the medial supracondylar ridge of the distal femur that is considered by many to be the result of an avulsion injury to the adductor magnus muscle
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Diffuse periostitis Ddx?
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Chronic venous stasis(most commone
Hypertrophic pulmonary osteoarthrtis(clubbing) - fibrous tumor of pleura a/w it Pachydermoperiostitis Hyper vitamin A Caffey dz (involves jaw) XRT |
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What affects angle of mandible?
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Myeloma
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What do you think with exuberant callus formation around fx?
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Nonstable fx
Paraplegics |
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Margins of a bone island?
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Typically spiculated
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Achondroplasia - spine findings
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Narrowing of interpedicular space as you go caudally
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Disorders where you can see multiple bone islands?
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Osteopoikiolosis
Tuberous Sclerosis |
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Causes of AVN
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SS
Steroids SLE ETOH Trauma Pancreatitis Casson 0 Scuba diving Gauchert's |
