Clinical - Radiology: Msk

Front 1

vacuum disc

Back 1

air visible in a degenerated disc in osteoarthritis

Front 2

Classic findings for osteoarthritis on plain film (4)

Back 2

osteophyte formation, joint space narrowing, subchondral cysts, and joint line sclerosis

Front 3

umbrella osteophyte

Back 3

forms around the entire periphery of the femur or humeral head

Front 4

intramuscular calcification presenting as calcareous fascial sheets and subcutaneous calcification presenting as linear sheets of calcification

Back 4

poly/dermatomyositis - inflammation leads to atrophy, edema, and calcification in muscle

Front 5

What causes scapholunate advanced collapse (SLAC)?

Back 5

disruption/damage of the scapholunate ligament - CPPD can cause (pseudogout)

Front 6

femoral notching sign

Back 6

scalloping of the anterior aspect of the femur by the patella; occurs with loss of the patellofemoral joint space

Front 7

Causes of chondrocalcinosis (calcification of cartilage)

Back 7

DJD, CPPD (pseudo-gout), Gout, Acromegaly, Hemochromatosis, Hyperparathyroidism, Ochronosis, Wilson’s disease, Oxalosis

Front 8

Causes of sclerotic bone lesions

Back 8

Sclerotic bone metastases are most frequently due to prostate cancer in males, breast cancer in females, and Hodgkin’s lymphoma

Front 9

Codman's triangle

Back 9

aggressive form of periosteal reaction; periosteum separates from cortex of bone

Front 10

What is a periosteal reaction? What causes it?

Back 10

Periosteal reaction occurs in response to acute or chronic insult to cortical long bones and has a long differential

Front 11

Hair-on-end periosteal reaction

Back 11

Spiculated, perpendicular periosteal reaction, termed “hair-on-end,” as in this patient, is aggressive and highly suggestive of Ewing’s sarcoma (diaphyseal)

Front 12

Non-common cause of hair-on-end periosteal reaction

Back 12

Chronic osteomyelitis (not Ewing's)

Front 13

DDx for Hypertrophic osteoarthropathy (thick, fluffy, symmetric periosteal reactions along shafts of multiple long bones, sparing the epiphysis)

Back 13

pulmonary: primary intrathoracic neoplasms e.g. non-small cell lung cancer and mesothelioma, as well as suppurative lung lesions e.g. lung abscess, bronchiectasis, empyema, and cystic fibrosis
Non-pulmonary: biliary cirrhosis, ulcerative cholitis, and Crohn’s disease

Front 14

What is Caffey Disease?

Back 14

a rare inflammatory disease of infancy with soft-tissue swelling and cortical hyperostosis of the mandible and facial bones. It may also involve the scapula, clavicle, ulna, and/or ribs. The pattern of thick periosteal reaction is nonaggressive

Front 15

Chondroblastoma

Back 15

benign cartilage producing lesions that typically occur in the epiphyses of skeletally immature patients.
-->The lesions are lytic and may have a sclerotic margin;
-->laminated AND disorganized periosteal reaction

Front 16

"onionskin" periosteal reaction

Back 16

laminated proliferation of periosteum: sarcomas, osteomyelitis, and chondroblastomas

Front 17

central nidus with surrounding SOLID periosteal reaction - classic for what?

Back 17

osteoid osteoma, which is a benign bone-forming tumor affecting children and adolescents

Front 18

solid periosteal reaction with marginal erosions

Back 18

psoriatic or reactive arthritis

Front 19

sunburst periosteal reaction?

Back 19

osteosarcoma
-->often secondary to Paget's disease

Front 20

increased density, size, and coarsened trabeculae of the entire visualized bone

Back 20

Paget's

Front 21

Sail sign

Back 21

separation of anterior fat pad from the bone; indicates fluid in the joint space, very suspicious of fracture
-->appearance at all of the posterior fat pad is also indicative of fluid

Front 22

rugger jersey spine

Back 22

alternating sclerotic and lucent bands in the vertebrae; central horizontal stripe of lucency
-->sign of hyperparathyroidism

Front 23

H-shaped vertebrae

Back 23

The central area of the vertebral bodies are not as tall as the periphery of the vertebral bodies
-->sickle cell anemia

Front 24

Triad of renal osteodystrophy

Back 24

diffuse osteosclerosis
Secondary hyperparathyroidism
Osteomalacia

Front 25

Where is osteosarcoma, who gets it, what does it look like

Back 25

metaphysis of long bones, esp femur and tibia
15-25 yr olds or >55 with Paget
Sclerotic lesion with densities in surrounding soft tissue

Front 26

triad of paget's disease

Back 26

increased bone density, increased bone size, coarsened trabeculae

Front 27

How do you recognize a super scan on bone scintigraphy

Back 27

The kidneys do not light up but everything else does!

Front 28

ground glass bone?

Back 28

diffuse - osteomalacia
focal - fibrous lesions

Front 29

Sail sign

Back 29

fat pad separating away from the bone - indicative of fluid in the joint space and highly suspicious of fracture

Front 30

tumor in the metaphysis?

Back 30

osteosarcoma

Front 31

tumor in the diaphysis, very young child?

Back 31

Ewing's

Front 32

tumor in the epiphysis

Back 32

Giant cell

Front 33

dense matrix with "clouds and clumps"

Back 33

osteoid lesion

Front 34

dense matrix with rings and C's

Back 34

chondroid

Front 35

what is the only non-aggressive type of periosteal reaction?

Back 35

solid and continous

Front 36

What are the terms used to describe the border of a bone lesion (3)?

Back 36

geographic - non-aggressive
moth-eaten
permeative

Front 37

What is the first question to ask yourself when faced with a bone lesion?

Back 37

aggressive or non-aggressive?

Front 38

Colles' fracture?

Back 38

distal radius after FOOSH in older people

Front 39

H-shaped vertebra

Back 39

sickle cell anemia - due to chronic ischemia; will always see a SCLEROTIC vertebral body

Front 40

fish-mouth or codfish vertebra

Back 40

compression fractures! Will always see a LUCENT vertebral body

Front 41

Three possible bone findings in multiple myeloma

Back 41

1. punched out lytic lesions
2. diffuse osteopenia
3. osteosclerosis (very rare - slow growing type)

Front 42

bone scan in multiple myeloma

Back 42

may look normal - osteoblasts have no time to respond and hence are not overactive

Front 43

Four possibilities if a bone is bent or bowed

Back 43

osteomalacia, osteogenesis imperfecta, Paget's, fibrous dysplasia

Front 44

Common site of bone resporption in secondary hyperparathyroidism?

Back 44

distal clavicles - wide AC joint

Front 45

subperiosteal reabsorption of the 2nd and 3rd proximal and middle phalanges on the radial side

Back 45

hyperparathyroidism

Front 46

what do infarcts look like in bone?

Back 46

sclerotic!

Front 47

bone tumor with pain at night relieved by NSAIDS

Back 47

osteoid osteoma

Front 48

Boxer's Fracture

Back 48

4th or 5th metacarpal head

Front 49

Galeazzi Fracture

Back 49

radial mid diaphyseal fracture AND distal radial ulnar joint dislocation

Front 50

Monteggia Fracture

Back 50

fracture of ulna and anterior radial head dislocation

Front 51

Osgood Schlatter DIsease

Back 51

painful tibial tuberosities - due to microavulsions in a growing young person

Front 52

What is an exostoses?

Back 52

It is a spur like defect in bone at the metaphysis with a cartilage cap; benign; caused by growth plate cartilage misplaced in the metaphysis - danger is nerve compression

Front 53

Appearance of AVN

Back 53

# Early AVN may present with a crescentic lucency below the cortex.
# Moderate AVN usually shows sclerosis of the head.
# Advanced AVN shows inhomogeneous sclerosis and flattening of the femoral head as in this patient.

Front 54

periarticular erosions are common in what type of arthritis?

Back 54

Gout

Front 55

What is this?

Back 55

neuropathic arthritis

Front 56

Findings and diagnosis

Back 56

Reactive Arthritis
# There is a marginal erosion of the 5th metatarsal.
# There is a calcaneal erosion and adjacent soft tissue calcification (enthesiopathy)

Front 57

What is Maffucci's Syndrome

Back 57

multiple enchondromata

Front 58

Findings and diagnosis

Back 58

Findings

* The plain film demonstrates cystic areas in the femoral head and the acetabulum with joint space narrowing from secondary osteoarthritis. This is due to the diffuse type of PVNS.
* There are T2 bright cystic areas in the femoral head and acetabulum with a joint effusion.

Discussion

Pigmented Villonodular Synovitis (PVNS) is a synovial proliferative process. Slow growing masses grow in the joint space and can cause erosion of the adjacent bone and pain. PVNS can be diffuse (as in this case) or focal and is most common in the knees, hips, and ankles, but can occur in any joint.

Front 59

Maisoneuvre Fracture

Back 59

Slipping of distal tibio-talal joint; fracture of proximal fibula

Front 60

Causes of chondrocalcinosis

Back 60

Causes include DJD, CPPD (pseudo-gout), Gout, Acromegaly, Hemochromatosis, Hyperparathyroidism, Ochronosis, Wilson’s disease, Oxalosis

Front 61

Hair-on-end periosteal reaction

Back 61

Ewing's or osteomyelitis

Front 62

Three causes of a solid periosteal reaction

Back 62

osteoid osteoma, psoriasis arthritis, reactive arthritis

Front 63

lytic epiphyseal tumor?

Back 63

giant cell tumor

Front 64

longitudinal ligament ossification in the spine is a sign of what

Back 64

ankylosing spondylitis

Front 65

What is DISH? What are the findings?

Back 65

DISH occurs in the cervical and thoracic spine. Patients have back pain, back stiffness, and may have dysphagia. Cardinal features include ossification of the anterior longitudinal ligament bridging at least four vertebral bodies, lucency between anterior vertebral body and anterior longitudinal ligament, preservation of intervertebral joint space, and enthesophytes are frequently seen at tendonous insertions in the pelvis.

Front 66

Gamekeeper's fracture

Back 66

Gamekeeper's fracture is an avulsion of the ulnar collateral ligament (UCL) of the thumb. It is also called Skier’s Thumb and results from severe hyperabduction.