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95 Cards in this Set
- Front
- Back
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DID and PIP arthropathy
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No erosions
-OA -CPPD Erosions -Erosive OA -Psoriasis -Multicentric histiocytosis -Gout -RA - PIPs only |
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Systemic Lupus Erythematosis
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-No erosions
-Reducible subluxation -Calcification -Acro-osteolysis DDX: -Jaccoud's arthropathy |
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Synovial Osteochondromatosis (primary)
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-Synovial metaplasia
-Monoarticular - #1 knee -2/3 ossify -Treat with synovectomy |
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Synovial Chondromatosis
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-Pressure erosions in tight joints
DDx: - PVNS (distinguish with MRI - would bloom on gradient echo due to hemosiderin) -synovial hemangioma -amyloid |
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Osteoarthritis hand
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-DIPs and thumb
-Does Not involve MCPs |
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Erosive osteoarthritis
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-Seagull erosions (cental)
-Middle aged women -PIP, DIP, 1st CMC -DDx: psoriatic |
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Psoriatic arthritis
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-Single digit - "sausage digit"
-"Mouse ear" (marginal), then "pencil-in-cup" erosion -"Fluffy" periosteal reaction -PIP>DIP, and intercarpas -NO osteopenia -Deformities -DDx: erosive OA |
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Multicentric Reticulohistiocytosis
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-PIP and DIP erosions
-Lumpy bumpy soft tissue -Women -25% malignant |
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Gout
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-Lump bumpy soft tissue (also in sarcoid, amyloid, multicentrric reticular histiocytosis)
-Punched out erosions (tophi in bone) - smooth, away from joint -Overhanging edges -No osteoporosis (vs RA) -Joint space preserved (vs RA) |
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Rheumatoid arthritis
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-Carpus (ulnar styloid)
-MCP and PIP -Marginal or central erosions -Erosions more prominent on radial side of distal MC -No osteophytes -Deformities -Ulnar subluxation at MCPs -Ulnar "drift"/translocation of carpus with respect to rad/ulna -Fusiform STS around joint Surgery -Fusion -Swanson prostheses (plastic - look like erosions) -Silastic prostheses can cause synovitis (like particle disease) |
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CPPD arthropathy (vs. OA)
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-radiocarpal (vs. OA)
-SLAC wrist -drooping osteophyte on radial aspect of 2nd or 3rd MC head -DIP and PIPs ok (vs.OA) -chondrocalcinosis - but not always -subchondral cysts can be large ->50yrs -DDx: -Hyperparathyoroidism -Renal osteodystrophy -Hemochomatosis |
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Juvenile Idiopathic Arthropathy (JIA)
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-Overgrown epiphyses
-Premature epiphyseal fusion -Narrowing, erosions, fusion later -Carpas and CMCs |
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Hip arthropathy
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Superolateral and medial narrowing
-OA Axial = superomedial -RA* -JIA -CPPD - pubic symphysis narrowing, cysts common, >50 -AS - fused SI joint, spine (syndesmophytes, tram track), whiskering -Infection - unilateral, diffuse narrowing, teardrop distance increased, bulging fat planes |
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Knee arthropathy
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CPPD
- isolated PF narrowing ("wrapped patella") - saucerization - smooth narrowing above PF joint - calcification Pigmented villonodular synovitis -hemosiderin (susceptibilty on gradient) -knee (like synovial chondromatrosis) -young men -synovectomy Hemophilia / JIA -hemosiderin (just hemophilia) -enlarged epiphyses -prominent intercondylar notch -squaring of patella -medial and lateral narrowing |
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Ankles and feet arthropathy
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Reactive arthritis (Reiter's)
-calcaneal erosions -retrocalcaneal bursitis -IP joint of great toe - pencil in cup (also psoriatic) -osteitis of distal phalanx (looks like osteo on MR) Neuropathy -OA with a vengeance -density, disorganization, debris, dislocation, degeneration -diabetes -atrophic form - (syringomelia in shoulder) Rheumatoid Arthritis -lateral 5th MT, medial 1-4th MT erosions -hallux valgus |
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High riding shoulder
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-distance b/w acromion and top of HH <6mm
-means rotator cuff tear -CPPD and RA associated |
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Spine arthropathy
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Rheumatoid arthritis (c-spine)
-atlantoaxial subluxation >3mm -basilar invagination - odontoid migrates up -odontoid, facet erosions -subluxation |
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Sacroilitis (seronegative spondyloarthropathy)
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-sclerosis around SI joints
-iliac side prior to sacral side -MRI with gad - joint uptake DDx: AS and IBD -bilateral symmetric -syndesmophytes (marginal and vertical) -shiny corners (fat deposits in VB) -squaring of VB (L-spine) -fusion -psuedoarthrosis - fracture esp. at cervicothoracic jxn Psoriatic and reactive -bilateral ASsymetric -paravertebral ossification (nonmarginal, not vertical, one side of disc) |
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Soft tissue calcification
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Hydroxyapatite deposition disease (HADD)
-fluffy, amorphous -inflammatory response - STS, erosion -under anterior arch of C1 - longus colli muscle CPPD -linear, punctate Gout -round tophi usually low signal on MRI (can distinguish from infection) Collagen vascular disease -Dermatomyositis - sheet-like calcifications -Scleroderma - subq calcs, thin skin, acro-osteolysis Renal osteodystrophy -calcium fluid levels (tea-cup calcs) Tumoral Calcinosis -chicken wire septae |
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Acro-osteolysis
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Collage vascular ds
Raynoud's Psoriasis Hyperparathyroidism Frostbite (thumb spared) |
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Soft tissue masses (benign)
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Bursitis at elbow (olecranon bursa)
-gout and RA Ganglion -hand or wrist Paralabral cyst -shoulder, hip, knee Benign peripheral nerve sheath tumor -neurofibroma -schwannoma -localized (most common) -diffuse -plexiform - NF-1, follows branches, bag of worms, multiple target sign, symmetric in extremities |
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Generalized Osteopenia
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-Osteoporosis
-Osteomalacia -HyperPTH -Multiple myeloma |
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Localized Osteopenia
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Disuse
Reflex Sympathetic Dystrophy (Complex regional pain syndrome) -3rd phase of bone scan most accurate with diffuse periarticular uptake Transient regional osteoporosis of the hip -ddx of exclusion - usually underlying stress fx |
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Rickets and osteomalacia
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Abnormal mineralization due to Vit D deficiency
Rickets - kids -growth plate is target -bowing of the long bones -widening, fraying, of metaphyses and physis -knee, wrist, costochondral jxn ("ricketic rosary") Osteomalacia -mature bone is target -Looser's zone ("pseudofracture") - linear lucency that traverses part of the bone -prox femur, lateral scapula, prox tibia |
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Hyperparathyroidism
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Subperiosteal resorption -radial aspect of phalanges
Trabecular resoprtion -salt and pepper skull Subligamentous resportion -Undersuface of clavicle Subchondral resporiton -AC and SI joints Brown tumor -focal area of osteolysis Look for staghorn calculi in kidneys (causes hypercalcemia) Primary - autonomous hyperfxn from a parathyroid adenoma Secondary - hypocalcemic stimulus such as renal failure, malabsorption Tertiary - chronic 2ndary resulting in autonomous PTH hyperfxn |
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Renal osteodystrophy
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-Rugger jersey spine - bands of sclerosis along endplates
-Dense bones -Soft tissue calcs (dystrophic) Bone abnormalities in pts with CRF due to -2ndary hyperparathyroidism -osteomalacia - coarse, indistinct trabeculae |
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Hypoparathyroidism
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Deficiency of PTH production
-usually post-surgical - hypocalcemia Osteosclerosis Soft tissue calcs (subq, basal ganglia) |
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Pseudo and pseudo pseudo-hypoparathyroidism
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-Obese and short stature
-Brachydactyly (short digits - MCs) -Soft tissue calcs |
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Hypothyroidism
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-delayed growth
-wormian bones -stippled, fragments epiphyses -scfe |
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Thyroid acropachy
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-fluffy periostitis and STS - pathognomonic
-very rare -occurs in <1% of hyperthyroidism after tx when then are no longer hyper |
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Acromegaly
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Excess growth hormone from pituitary adenoma
-bone and ST overgrowth -thickened heel pad with enthesophytes -enlargement of tuft and base of distal phalanx -enlarged sella turcica |
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Scurvy
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Vit C deficiency
-osteoporosis -subperiosteal hemorrhage -relative sclerosis (on background of osteoporosis) at epiphysis (Wimburger's ring) and metaphysis -metaphyseal corner fx DDx: TORCH inf neuroblastoma methotrexate |
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Multiple lytic lesions
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FEEMHI
Fibous dysplasia EG Enchondroma Mets/myeolma Hyperparathyoroidism Infection |
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Osteoblastic
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BENIGN
-enostosis (bone island) -osteoid osteoma -osteoblastoma MALIGNANT -osteosarcoma -blastic met (prostate, breast, GU) |
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Enostosis
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DDx: blastic mets (prostate, breast, GU)
-NEG bone scan -signal voids in marrow Osteopoikilosis -multiple bone islands -epiphyses and metaphyses -clinically insignificant |
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Osteoid osteoma
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-Nidus <1.5cm surrounded by dense reactive bone
-Recommend CT (difficult to see nidus with all edema on MR) -HOT on bone scan DDx: Brodie's abscess |
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Osteoblastoma
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-nidus >1.5cm
-histosology similar to osteoid osteoma -targets - posterior elements of spine and ribs (unlike OO) -expansile, sclerotic or lyitc -HOT on bone scan |
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Lytic lesions in posterior elements
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"Go Ape"
GCT Osteoblastoma ABC Plasmacytoma EG |
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Osteosarcoma
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Conventional (75%)
-metaphyses -permeative, coritcal destruction, osteoid matrix, aggressive periosititis -soft tissue mass -mets to LUNGS, BONE (skip lesion 10%) Telangiectatic (10%) -aggressive -lytic, minimal osteoid -hemorrhagic (fluid-fluid levels) Parosteal (<5%) -low grade, good prognosis -exophytic, densely mineralized Periosteal (<1%) -extrinsic -saucer-like coritcal erosion Secondary (5%) -age >60 -risk factors: pagets, XRT |
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Chondroid tumors
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BENIGN
Enchondroma Chondroblastoma Osteochondroma MALIGNANT Chondrosarcoma |
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Enchondroma
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Chondroid matrix -except HAND
Complications: fracture, chondrosarcoma Multiple enchondromas (Ollier and Maffucci Syndrome) -kids - assymetric, limb deformity -chondroid lytic regions -columnar configuraiton -sarcomatous transformation -Maffxucci - soft tissue hemangiomas (phleboliths), high rate of sarmcomatous transformation (>20%) |
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Osteochondroma
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-metaphysis of long bones
-cortex in continuity with host bone -sessile or pedunculated -cartilage cap <1.5cm in adults Multiple Hereditary Osteochondromas -knees, shoulders, hips -complications more common with MHO Complications: -neurovascular impingemenet -fracture -bursitis -malignant transformation into chondrosarcoma (carilage cap >1.5cm) |
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Chondrosarcoma (vs. Osteochondroma)
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-pain
->4cm in axial skeleton or flat bone -aggressive features - cortical destruction, soft tissue mass -bone scan - lesion activity > anterior iliac spine in that pt (not case with enchondromas) |
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Fibrous lesions
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BENIGN
-fibrous dysplasia -non-ossifying fibroma (NOF) MALIGNANT (uncommon) -fibrosarcoma and malignant fibrous histiocytoma (aggressive, soft tissue mass) |
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Fibrous dysplasia
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-developmental (not neoplastic)
-<30 -no periostitis -"Shepard's Crook Deformity" - varus deformity of proximal femur -"long lesion in a long bone" -intense uptake on bone scan Monostotic (85%) or polyostotic (15%) McCune Albright -polyostotic FD -cafe-au-lait spots -precocious puberty |
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Non-ossifying fibroma
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-most common bone lesion
-<30 -NOF (>2cm) and FCD (<2cm) -metaphyses -eccentric -sclerotic margins -Don't touch |
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Vascular tumors
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BENIGN
-hemangioma (coarse trabeculations, fat - high T1 on MR) -glomus tumor (sharply marginated erosions in distal phalanx) -ABC (reactive vascular process with hx of trauma or other tumors) MALIGNANT -angiosarcoma (aggressive, soft tissue mass, phlebolith) |
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ABC
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2/3 assoc with prior trauma
1/3 assoc with bone tumor: -GCT -chondroblastoma -osteoblastoma DDx fluid-fluid level: -telangiectatic osteosarcoma -ABC (GCT, OC, OB) |
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SBC
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-true cyst in kids
-metadiaphyseal -evolves from lytic to sclerotic with time -fracture - fallen fragment -follows fluid signal with peripheral enhancement on MR |
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LCH
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-simulate infection (fever, WBC)
-prognosis depends on extent of ds and age -geographic lytic lesion, non-sclerotic margin, no matrix Localized (70%) - favorable prognosis Multipfocal (30%) - younger, poorer prognosis -"beveled edge" - uneven osteolysis of inner and outer tables of skull -"vertebra plana" - pathologic collapse of vertebral body |
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Giant cell tumor
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-skeletally mature - close physes
-eccentric, subarticular, non-sclerotic margin -knee, wrist, pelvis Ddx: Chondroblastoma Chondrosarcoma, mets, myeloma Post-traumatic cyst |
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Ewing Sarcoma
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-small round cell blue tumor (LCH and osteomyelitis)
-diaphyses, flat bones -age 10-15 |
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Chordoma
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-low-grade malignancy
-arises from notochord remnants -soft tissue mass -sacrum > clivus > vertebral body DDx: Chondrosarcoma GCT Plasmacytoma Mets |
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Adamantinoma
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-rare
-tibial midshaft -bubbly eccentric lesion |
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Mets
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Lytic
lung > kidney > breast Blastic prostate > breast > bladder "Ivory vertebral body" |
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Patient Age
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1-15: LCH
5-30: Osteosarcoma Ewing's NOF SBC ABC Fibrous Dysplasia Chondroblastoma 20-50: GCT >30: Chondrosarcoma, fibrosarcoma >40: Mets, myeloma |
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Lesion location
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Diaphsysis: Ewing's
Metaphysis: NOF Osteochondroma Sarcomas: osteo, chondro, fibro Epiphysis: Subchondral cyst Chondroblastoma GCT |
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Mallet / baseball finger
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-unopposed flexion at DIP
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Volar plate fx
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-occurs with finger dislocation
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Gamekeeper's / skier thumb
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-ulnar collateral ligament injury
-angle at MCP is too big Stennor lesion -UCL balls up and gets outside an aponeurosis |
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Keinboch's disease
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-AVN of lunate
-assoc with negative ulnar variance |
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Ossification centers of the elbos
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C I T E 1 7 10 11
form "X" capitellum medial epicondyle trochlea lateral epicdonyle |
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Radiograph lines at elbow
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anterior humeral line - should intersect middle 1/3 of capitellum (on flexion)
-if not - supracondylar fx radial capitallar line - radial head should always intersect the capittelum |
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Monteggia / Galiazzi / Essex lopresti
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MUGR
Monteggia - ulnar fx (+radial dislocation) Galiazzi - radius fx (+ulnar dislocation) Essex lopresti - radial head fx + dislocation at radioulnar joint |
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Lateral ridge of trochlea
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fx that involves the lateral ridge of the trochlea is LESS stable
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Hill-sachs / Bankart
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Anterior shoulder dislocation
Hill-sachs -posterolateral HH -(highest images of HH on MR should be perfectly round) Bankart -avulsion of anteroinferior labrum, disruption of scapular attachment -ALPSA lesion variant - balled up labrum inferomedial to glenoid -Perthes lesion - avulsion of anterior inferior glenoid with intact scapular attachment - best seen on abduction external rotation (ABER) Posterior shoulder dislocation Reverse Hill-sachs -anteromedial HH - "trough's sign" Reverse bankart -posterior glenoid |
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AC joint separation
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-Grade 1 - pain, no separation
-Grade 2 - AC >3-5mm, -Grade 3 - separation of coracoclavicular joint (disruption of coracoclavicular ligaments) When comparing sides: >3mm difference b/w AC joints >5mm difference b/w CC joints |
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Frieberg's infraction
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-osteochondrosis
-AVN / repetitive stress injuory of 2nd MTP due to congenitally long 2nd toe or high heels |
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5th metatarsal fractures
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-avulsion of tip - where peroneus brevis tendon attaches (hard shoe)
-Jone's fracture - 1-2cm more distal (crutches- can't bear weight) |
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Lisfranc
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-lisfranc ligament connects medial cuneiform with 2nd MT
on AP - 1st and 2nd MTs should line up with tarsals on oblique - 3rd and 4th MTs should line up with tarsals on lateral - MTs are dorsal to the tarsals get weight bearing views |
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Ankle sprain
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Don't miss
avusion of anterior process of calcaneus lateral process of talus (snowboarders) base of 5th MT |
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Calcaneal fractures
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Sanders classification
-articulating surface of fx with respect to the posterior (widest) facet of talus -lateral, central, medial, sustentaculum are the four columns (from medial to lateral) tendons incarcerated b/w fragments -flexor hallicus -perineal tendons (hug lateral cortex of calcaneus) |
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Segond fracture
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-avulsion of lateral tibial rim (not plateau)
-avulsion iliotibial band / lateral capsule -sign of ACL tear (>95%) -lat > medial meniscal tears (50%) -don't induce edema of underlying bone (occult) - can't see on MR! |
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Pelvic fractures
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Anterior blow - widening of SI joints from widening of anterior SI ligaments
pubic symphysis >2.5cm - critical lateral compression - look at arcuate lines (sacral fx) vertical sheer - complete disruption of SI joint |
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Acetabular fractues
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tranverse fx
-separates wing from ring (on xr, horizontal) -on CT, line is from front to back (separates acetabulum into right and left halves) anterior column fx -iliopectineal line disrupted -ilioischial line intact -on CT, horizontal line separates the acetabulum into front and back halves |
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Tarsal sinus syndrome (sinus tarsi)
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Trauma - mostly inversion sprain
Inflammatory arthritis Check lateral ligaments (PTT) Can't make diagnosis in acute ankle -abnormal signal in sinus tarsi - dark on T2 / bright on T2 |
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Capitellar ostechondral defect
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-pitcher with elbow pain
-unstable if surrounded by high T2, enhances, or cystic signal DDx: Panner's = osteochondrosis (osteonecrosis) 13-16yo (vs Panner's ds 5-11) Ossification of capitellum complete (vs Panner's) Loose bodies (vs Panner's) |
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Discoid meniscus
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-abnormally shaped meniscus
-bow-tie on three consecutive slices -signal does not have to extend to edge to be a tear -not all are complete |
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Achilles partial tear / tendinopathy
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Rounded tendon
Loss of anterior concavity |
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Meniscal tear
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PD or T1-weighted images ideal
Bucket handle -unstable vertical tear -pain, locking -double delta sign Radial tear -free edge to periphery (perpendicular to meniscal axis) -top to bottom on coronals -interrupt bow-tie on sagittals -most involve the body of the meniscus |
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Transient patellar dislocation
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-kissing contusions (medial patella, lateral femoral condyle)
-medial retinaculum injury Look for cartilage remnants! |
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Lymphoma
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Soft tissue mass with sparing of cortex and ...
Striking MRI/bone scan findings and.. Normal radiograph |
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Benign myxoma
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No fat sat, enhancement variable, septae (not simple)
DDx: hematoma abscess benign nerve sheath tumor malignant fibrous histiocytoma |
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Benign vs pathologic compression fracture
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Both show abnormal T1 signal in first 3-6months
BENIGN Preserved marrow signal in some areas Retropulsion Will return to fatty marrow MALIGNANT Abnormal signal in posterolateral corner of VB extending to PE Rounded, bulging Soft tissue mass |
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Regional dark signal on T1
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-Reconversion to red marrow
-Infiltration - myeloproliferative disorders (polycythemia vera) -Depletion -Edema -Ischemia -Mets |
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Peroneus brevis tendon tear
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-brevis in front of or medial to longus
-Longus is Lateral |
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Lipoma arborescans
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-high T1 bodies which fat sat out
-see in RA or OA -synovectomy DDx: synovial osteochondromatosis - should see bodies on radiograph PVNS - blooming on MR fat from fracture - see on radiograph |
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Spontaneous osteonecrosis (SONC / SINC)
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-Acute onset of pain (usually female)
-Stress reaction of medial femoral condyle (medial aspect) -Assoc. with meniscal tear and osteopenia -Often post-op s/p menisectomy -Insufficiency fx, no osteonecrosis as originally thought DDx: -osteochondritis dissecans -infarcts - serpentine |
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Osteochondritis dissecans
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-younger patients
-occurs near the notch of the medial femoral condyle -high signal interface with parent bone -knee, ankle, elbow |
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Transient osteoporosis
(Transient bone marrow edema syndrome in hip) |
-males > females (3rd trimester pregnancy)
-self-limited -osteopenia without joint space narrowing -HOT on bone scan -edema and effusion on MR |
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Femoral acetabular impingement (FAI)
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-abnormal contact between prox femur and acetabular rim with repetitive motion
-predisposes to labral tears Cam - younger males -asphericity of fem head-neck jxn ("pistol-grip deformity") Pincer - middle aged females -acetabular overcoverage Most are MIXED types! |
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Ulnocarpal impaction syndrome
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-triangulofibrocartilage (TFC) perforation or degeneration
-ulnar hits lunate and triquetrum (cysts, sclerosis, erosion) -lunotriquetral ligament tear -osteotomy of ulnar head |
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Rotator cuff tears
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-high riding humeral head
-"tangent sign" - supraspinatous muscle should go above Y on sagittal (if below, atrophic) |
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Biceps tendon dislocation
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-usually tear in subscapularis tendon tear also
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Suprascapular nerve entrapment
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-mixed sensory and motor nerve
-suprascapular notch - supraspinatus and infraspinatous -spinoglenoid notch - infraspinatous only |
