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100 Cards in this Set
- Front
- Back
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Only in patients <30 years of age
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Aneurysmal bone cyst
Solitary bone cyst Nonossifying fibroma Chondroblastoma Chondromyxoid fibroma Eosinophilic granuloma |
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Automatics by age
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<30 y/o: EG, infection
>40 y/o: metastases, multiple myeloma, infection |
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Multiple lesions
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Fibrous dysplasia
EG Enchondromas Metastases, multiple myeloma Hyperparathyroidism (brown tumors) Infection |
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Lesions without associated pain
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Fibrous dysplasia
Enchondroma NOF UBC |
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Similar appearing lesions
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ABC + osteoblastoma
Chondroblastoma (child, adolescent) + clear cell chondrosarcoma (adult) Chondromyxoid fibroma (calcified matrix is NOT seen) + NOF |
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Bubbly lesion of bone
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FEGNOMASHIC mnemonic:
Fibrous dysplasia EG, enchondroma Giant cell tumor NOF Osteoblastoma Metastases, multiple myeloma (plasmacytoma) ABC Simple bone cyst Hyperparathyroidism (Brown tumor), hemangioma Infection (Brodie’s abscess, coccidiodomycosis, cryptococcus) Chondromyxoid fibroma, chondroblastoma |
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Ill-defined lytic lesion
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Metastasis
Multiple myeloma Ewing’s sarcoma Acute osteomyelitis Eosinophilic granuloma Lymphoma/leukemia Telangiectatic osteosarcoma (child, metaphysis) Malignant fibrous histiocytoma Fibrosarcoma (metaphysis) Hemangioma |
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Expansive lytic lesion
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Metastasis: thyroid carcinoma, RCC
Multiple myeloma (ribs) ABC GCT (no sclerosis) Hemophiliac pseudotumor Brown tumor Enchondroma: Ollier’s disease, Maffuci’s disease NOF Fibrous dysplasia |
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Multiple lytic lesions
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Metastases: breast, lung, RCC
Multiple myeloma (ribs especially) Osteomyelitis (hematogenous) Fibrous dysplasia (unilateral polyostotic) Brown tumor Eosinophilic granuloma Lymphoma/leukemia Enchondroma: Ollier’s disease, Maffuci’s syndrome |
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Epiphyseal lytic lesion (apophysis)
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Geode: OA, CPPD, RA, AVN
Intraosseous ganglion (classically the medial malleolus) GCT Chondroblastoma Clear cell chondrosarcoma (similar to chondroblastoma) EG Infection (Brodie’s abscess) Brown tumor |
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Red marrow lesions
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Metastases
Multiple myeloma Ewing’s sarcoma Lymphoma |
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Well-defined sclerotic lesion
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Metastasis: prostate, breast, bladder, colon, carcinoid, Hodgkin’s lymphoma, medulloblastoma
Bone island Osteoid osteoma Osteoblastoma Mature bone infarct: SCD, SLE Enchondroma Low grade chondrosarcoma Fibrous dysplasia Healing stress fracture (metatarsal shafts, calcaneous, tibia, femur, pubis, sacrum) Involuting lytic lesion: NOF, others |
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Ill-defined sclerotic lesion
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Metastasis: prostate, breast, bladder, colon, carcinoid, Hodgkin’s lymphoma, medulloblastoma
Immature bone infarct/osteonecrosis Osteosarcoma (amorphous, cloud-like) Chondrosarcoma (rings, arcs) Hodgkin’s lymphoma Chronic osteomyelitis Stress fracture (metatarsal shafts, calcaneous, tibia, femur, pubis, sacrum Paget’s disease (pelvis, femur, spine, skull, tibia) |
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Lesion with sequestrum
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Osteomyelitis (child)
EG Fibrosarcoma: de novo; Paget’s disease, chronic osteomyelitis, AVN, radiation osteitis MFH Desmoplastic fibroma (mandible, ilium, long bones) Lymphoma Metastasis (rare) Osteoid osteoma (pseudosequestrum) |
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Lesions with fluid-fluid levels
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ABC
GCT Chondroblastoma Osteoblastoma Telangiectatic osteosarcoma |
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Focal periostitis/cortical hyperostosis
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Osteoma: sporadic, Gardner’s syndrome
Osteoid osteoma Osteoblastoma Brodie’s abscess Stress fracture Parosteal osteosarcoma Cortical desmoid (posteromedial suprachondylar linea aspera of distal femur at adductor magnus insertion) Parosteal lipoma (rare) Melorheostosis (cortical/endosteal hyperostosis in a spinal nerve dermatomal distribution) |
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Diffuse periostitis, adult
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Hypertrophic osteoarthropathy (spares epiphyses): bronchogenic carcinoma, other pulmonary conditions, localized fibrous tumor of the pleura, cardiac disease, GI conditions
Pachydermoperiostosis Thyroid achropachy (feathery, usually after treatment) Venous stasis Fluorosis |
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Diffuse periostitis, child
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Physiologic
Caffey’s disease Child abuse Malignancy: leukemia, neuroblastoma metastases, multicentric osteosarcoma Congenital syphilis Hypervitaminosis A (>6 months) Scurvy (>6 months) PGE2 |
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Excessive callus formation
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Steroids: exogenous, Cushing’s disease
Inadequate fracture immobilization Paralysis: heterotopic ossification in SCI, neuromuscular disorders Osteogenesis imperfecta NO SIR mnemonic: Neuromuscular disorders, Osteogenesis imperfecta, Steroids, Infection, Reduction (poor) |
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Erlenmeyer flask deformity (undertubulation)
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Gaucher’s disease (rare)
Thalassemia, other severe anemias Niemann-Pick disease (rare) Osteopetrosis (rare) Metaphyseal dysplasia: Pyle’s disease (rare) |
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Enlarged bone
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Paget’s disease
NF-1 Acromegaly Hemangioma Macrodystrophia lipomatosa (rare) |
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Short metacarpal/metatarsal
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Idiopathic
Juvenile chronic arthritis Turner’s syndrome Pseudohypoparathyroidism, pseudopseuodhypoparathyroidism Trauma Sickle cell anemia |
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Dactylitis
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TB
Sickle cell anemia Psoriasis (sausage digit) |
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Erosion of distal clavicle
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Hyperparathyroidism
RA Post-traumatic osteolysis Cleidocranial dysplasia (dysostosis) Metastasis, multiple myeloma Infection: IVDA Scleroderma |
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High-riding shoulder (<1 cm from acromion)
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Rheumatoid arthritis
Rotator cuff tear CPPD |
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Diaphyseal bone lesions
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FEMALE mnemonic:
Fibrous dysplasia EG Metastasis Adamantinoma, osteofibrous dysplasia Lymphoma, leukemia Ewing’s sarcoma |
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Lucent metaphyseal bands
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Severe illness (defective osteogenesis)
Leukemia Neuroblastoma metastasis NL variant Scurvy (white line of Frankel, Trummerfeld lucent zone, Pelekan beak, Wimberger ring) Congenital infection (STARCH) Juvenile chronic arthritis Rickets (physeal widening, metaphyseal cupping/fraying ) |
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Juvenile chronic arthritis
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comprises Still’s disease (seronegative juvenile-onset RA), juvenile onset seropositive adult-type RA, seronegative spondyloarthropathy
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Dense metaphyseal bands
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Growth arrest/stress lines
Heavy metal poisoning: lead, arsenic, bismuth, mercury Osteopetrosis Hypothyroidism, hypoparathyroidism Hypervitaminosis D Leukemia Rickets (healed) Scurvy (white line of Frankel, Trummerfeld lucent zone, Pelekan beak, Wimberger ring) Congenital infection (STARCH) Osteopathia striata (Vooerhoeve’s disease): coexists with osteopoikilosis, melorheostosis, osteopetrosis |
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Epiphyseal irregularity
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AVN
Congenital infection (STARCH) Hypothyroidism Dysplasia epiphysealis multiplex: chondrodysplasia punctata, Meyer’s dysplasia Spondyloepiphyseal dysplasia Trisomy 18, 21 (accessory epiphyses) NL variant |
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Avascular necrosis
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ASEPTIC mnemonic:
Alcohol Sickle cell anemia, SLE, scleroderma Exogenous or endogenous steroids Pancreatitis Trauma Idiopathic: Legg-Calve-Perthes disease, Blount’s disease, Keinbock’s disease, Panner’s disease (capitellum); Iatrogenic: radiation, steroids Caisson’s disease (the “bends”), Gaucher’s disease |
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AVN stages
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Stage 0: NL imaging
Stage 1: NL x-ray/abn bone scan & MRI Stage 2: mixed lysis & sclerosis Stage 3: subchondral lucency Stage 4: fragmentation, collapse Stage 5: secondary OA |
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Epiphyseal overgrowth
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Hemophilia
Juvenile chronic arthritis Paralysis |
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Subchondral cyst
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DRIP mnemonic:
DJD RA Ischemic/avascular necrosis Pseudogout (CPPD) |
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SAPHO
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Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis, a chronic disease of relapses/remissions, occurs in the clavicles of children, and is treated with NSAIDS. Sacroiliitis occurs in 1/3rd of patients. Simulates Ewing’s sarcoma, EG, osteomyelitis
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Acroosteolysis
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Scleroderma
Injury: frostbite, burns, electrical injury Hyperparathyroidism Psoriasis Raynaud’s phenomenon/disease (white, blue, red): primary, secondary to scleroderma, RA, SLE, throacic outlet syndrome, methysergide intoxication, myxedema, trauma Neuropathic arthropathy: diabetes, syringomyelia, congenital indifference to pain Distal embolism Epidermolysis bullosa (rare) Congenital erythropoietic porphyria PVC exposure (thumb) Pyknodysostosis Idiopathic acroosteolysis of Hajdu and Cheney Leisch-Nyan syndrome |
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Acetabular protrusion
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Osteomalacia, rickets
RA (severe) Ankylosing spondylitis Infection OA (atypical medial migration) Paget’s disease Trauma Prosthesis, radiation Familial acetabular protrusion (Otto’s disease) |
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Diffuse osteosclerosis
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Metastasis: breast, prostate
Renal osteodystrophy Sickle cell anemia Osteopetrosis (sandwich vertebrae, rare) Pyknodysostosis Paget’s disease Mastocytosis (rare) Myelofibrosis Fluorosis MARBLE mnemonic: Myelofibrosis, Mastocytosis, Metabolic (hypervitaminosis D, fluorosis, hypothyroidism), Anemia (Sickle cell), Renal osteodystrophy, Blastic metastases (breast, prostate), Lymphoma, Enigmas: pyknodysostosis, osteopetrosis, melorheostosis, Paget’s disease, Tuberous sclerosis |
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Expansive lytic posterior element lesion
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Osteoblastoma
ABC TB EG |
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Coarse trabeculation
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Paget’s disease
Osteopenia Hemangioma Thalassemia Gaucher’s disease (rare) |
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Regional osteopenia
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Disuse osteoporosis
Reflex sympathetic dystrophy: trauma, infection, MI, stroke, calcific tendinitis Arthritis (periarticular osteopenia): RA, septic arthritis, severe gout, SLE Transient regional osteoporosis: transient osteoporosis of the hip, regional migratory osteoporosis AVN Ill-defined lytic lesion: osteomyelitis, neoplasm (telangiectatic osteosarcoma), lytic phase of Paget’s disease |
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Cortical striation/tunneling (rapid bone turnover)
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Thyrotoxicosis
RSD Disuse osteoporosis Hyperparathyroidism Paget’s disease (lytic phase) |
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Pseudopermeative pattern with cortical holes
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Hemangioma (ST phleboliths)
XRT Aggressive disuse osteoporosis |
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Permeative lesion
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LEMON mnemonic:
Lymphoma Ewing’s sarcoma, EG Multiple myeloma Osteomyelitis Neuroblastoma |
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Bone bowing
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Paget’s disease
Osteogenesis imperfecta Osteomalacia/rickets Fibrous dysplasia Growth plate injury: trauma (Salter-Harris 5 fracture), iatrogenic injury (ACL repair) NF-1 (anterior) Physiologic bowing of tibia (posteromedial) |
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Premature closure of physis
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Trauma: Salter-Harris 5 fracture
Juvenile chronic arthritis Hemophilia Accelerated skeletal maturation: McCune-Albright syndrome (polyostotic unilateral fibrous dysplasia, endocrine abnormalities/precocious puberty, cafe-au-lait), hyperthyroidism |
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Well-formed bone spurs
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Degenerative enthesopathy
DISH Fluorosis Acromegaly Ankylosing spondylitis, other seronegative spondyloarthropathies |
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Poorly-defined bone spurs
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Psoriatic spondyloarthropathy
Reiter’s syndrome Ankylosing spondylitis Avulsion injury |
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Monoarticular arthritis
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Trauma
Infection: pyogenic arthritis (gonococcus, staphylococcus), TB Neoplasm: PVNS (rare), synovial osteochondromatosis Inflammatory arthritis: RA, seronegative arthritis, juvenile chronic arthritis Crystal-induced arthritis: gout, CPPD, calcium hydroxyapatite deposition disease |
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Purely erosive arthritis
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RA
Pyogenic arthritis (acute) TB (indolent) |
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Erosive and proliferative arthritis
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Psoriatic spondyloarthropathy
Reiter’s syndrome Ankylosing spondylitis (can mimic RA) Juvenile chronic arthritis Pyogenic arthritis |
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Arthritis with preserved joint space
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Gout (until late)
Hemophilia Amyloidosis TB (indolent course) Juvenile chronic arthritis Synovial osteochondromatosis Robust (cystic) RA (young male) Reactive synovitis: infections, neoplasms, IBD |
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Accelerated osteoarthritis
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Articular trauma
CPPD, hemochromatosis Ochronosis Acromegaly Articular dysplasia: spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, DDH |
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Destructive arthritis with sclerosis and debris
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Neuropathic arthropathy: diabetes mellitus, syphilis, syringomyelia, MS, leprosy, congenital indifference to pain
CPPD Chronic pyogenic arthritis Ochronosis (deposition of homogentisic acid; calcified intervertebral discs, ankylosis, DDD spine) |
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Neuropathic joint (5 D’s)
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Destruction
Debris Dense Dislocation Distension (effusion) |
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Calcified intraarticular loose body
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Synovial osteochondromatosis
Detached osteophyte (OA) Acute osteochondral fracture Osteochondritis dissecans (unstable fragment) Ochronosis |
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Joint effusion
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Surgical arthrodesis
Previous trauma Pyogenic arthritis Coalition Psoriatic spondyloarthropathy Reiter’s syndrome Ankylosing spondylitis Erosive OA RA (carpal, tarsal) |
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Olecranon soft tissue swelling (extensor surface)
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Gout
RA Bursitis Trauma |
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Ulnar deviation of metacarpophalangeal joints
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RA
SLE Jaccoud’s arthropathy: ligamentous laxity due to rheumatic fever |
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Radial deviation of metacarpophalangeal joints
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Juvenile chronic arthritis
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Sacroiliitis
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Ankylosing spondylitis
Psoriatic spondyloarthropathy Reiter’s syndrome Enteropathic arthropathy: IBD, Whipple’s disease Infection: pyogenic, fungal Hyperparathyroidism (erosions) Gout (less common) |
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Arthropathy with soft tissue masses
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Gout (Ca++ tophi only with concomitant renal disease)
Amyloidosis Nodular RA (pressure points of extensor surfaces) Muticentric reticulohistiocytosis |
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Amyloidosis vs PVNS
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similar on T2, but plain film shows osteopenia in amyloidosis
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PVNS vs giant cell tumor of tendon sheath
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similar on MRI, but GCTTS is located in the soft tissues near the joint
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Periarticular soft tissue calcifications
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Hydroxyapatite deposition disease
Gout Scleroderma (CREST syndrome), SLE, mixed connective disease Tumoral calcinosis: hypercalcemia (renal failure, milk-alkali syndrome, hyperparathyroidism, hypervitaminosis D, sarcoidosis) |
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CREST syndrome
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Calcinosis
Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia |
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Chondrocalcinosis
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CPPD
Hemochromatosis Hyperparathyroidism (primary > secondary) Gout |
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Spine spondylolistheses
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Spondylolysis
Facet degeneration Degenerative disc disease (retrolisthesis) Trauma Ligamentous laxity: Marfan’s syndrome, Ehlers-Danlos syndrome |
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Atlantoaxial subluxation
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Trauma
Arthritis: RA, seronegative spondyloarthropathy, multicentric reticulohistiocytosis Adjacent infection: pharyngitis, tonsillitis Congenital: Down syndrome, Morquio’s syndrome, congenital hypoplasia of dens/os odontoideum (Down syndrome, Moroquio’s syndrome) Occipitalization of C1 Ligamentous laxity: Marfan’s syndrome, Ehlers-Danlos syndrome |
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Ribbon ribs
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HORNS mnemonic:
Hyperparathyroidism Osteogenesis imperfecta RA NF-1 Scleroderma |
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Rib lesions
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Fibrous dysplasia
ABC Metastases, multiple myeloma EG Enchondroma Chondrosarcoma |
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Paravertebral ossification
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Asymmetric: psoriatic spondyloarthropathy, Reiter’s syndrome
Symmetric: Ankylosing spondylitis, enteropathic arthropathy Anterior: DISH (4 or more levels) Focal mass: TB |
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Disc calcification
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Degenerative disc disease (dystrophic)
Ochronosis (young adult) CPPD (chondrocalcinosis) Surgical fusion Ankylosing spondylitis Hemochromatosis |
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Ivory vertebrae
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Metastasis: breast, prostate
Paget’s disease Hodgkin’s disease > NHL Chronic osteomyelitis Discogenic vertebral sclerosis Osteosarcoma |
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Enlarged vertebrae
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Paget’s disease
ABC Acromegaly |
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Bullet-shaped vertebrae
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HAM D mnemonic:
Hypothyroidism Achondroplasia Mucopolysaccharidoses (middle/Moroqio’s, inferior/Hurler’s) Down syndrome |
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Posterior scalloping of vertebrae
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Increased spinal pressure: neoplasm (lipoma, neurofibroma, ependymoma), syringomyelia, hydrocephalus (long-standing)
Dural ectasia: NF-1, Marfan’s syndrome, Ehlers-Danlos syndrome Achondroplasia Acromegaly AMEN mnemonic: Achondroplasia, Acromegaly, Marfan’s syndrome, Ehlers-Danlos syndrome, NF-1 |
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Anterior scalloping of vertebrae
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Aortic aneurysm
Lymphadenopathy TB |
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Absent pedicle
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Metastasis
ABC Congenital absence (contralateral hypertrophy) |
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Dense pedicle
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Congenital absence of contralateral pedicle
Osteoblastic metastasis Osteoblastoma |
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Dense vertebral endplate
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Degenerative disc disease
Renal osteodystrophy (Rugger jersey) Excess steroids (marginal condensation): organ transplantation, RA, SLE, asthma; Cushing’s disease Discogenic sclerosis Osteopetrosis |
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Increased interpediculate distance
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Trauma
Syringomyelia Intraspinal tumor Dysraphism AVM |
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Expansive lesion of sternum
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MAC mnemonic:
Metastases, multiple myeloma ABC Chondrosarcoma |
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Blow-out lesion of the posterior elements
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ATOM mnemonic:
ABC TB Osteoblastoma Metastasis |
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Floating teeth
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EG
Leukemia, lymphoma Periapical abscess Neuroblastoma 10 mandibular tumor |
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Calcaneus lesions (epiphysis equivalent)
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GCT
Lipoma UBC Infection Chondroblastoma |
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Fatal Dwarf syndromes
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Jeune’s asphyxiating thoracic dystrophy: narrow chest, short horizontal ribs, handle bar clavicles, triradiate acetabulum
Homozygous achondroplasia (more severe than heterozygous): small foramen magnum, narrow interpediculate distance, posterior vertebral scalloping, square iliac bones (elephant ears), flat acetabulae, champagne pelvis with small sciatic notch, flared metaphyses Thanatophoric dwarfism: narrow chest, telephone receiver femurs with prominent spur of the inner proximal femur, platyspondyly, metaphyseal flaring/widening, small foramen magnum, short wide fingers. Look like homozygous achondroplasia, so check if both parents have achondroplasia Osteogenesis imperfecta (congenita): osteopenia, multiple fractures, wormian bones, exuberant callus, accordion shape femurs, platyspondyly. The differential includes child abuse, steroid osteoporosis, juvenile osteoporosis Hypophosphatasia: osteopenia, lucent skull, scooped out metaphyses Hurler’s disease: J-shaped sella, beaked vertebrae (inferior), posterior vertebral scalloping, thick phalanges, tapered proximal metacarpals, Madelung deformity, flared iliac wings, wide acetabular roof Moroqio’s disease: vertebra plana, beaked vertebrae (middle), hypoplastic dens, short wide phalanges, tapered proximal metacarpals, flat femoral epiphyses, flared iliac wings, wide acetabular roof |
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Jeune’s asphyxiating thoracic dystrophy:
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narrow chest, short horizontal ribs, handle bar clavicles, triradiate acetabulum
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Homozygous achondroplasia
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(more severe than heterozygous): small foramen magnum, narrow interpediculate distance, posterior vertebral scalloping, square iliac bones (elephant ears), flat acetabulae, champagne pelvis with small sciatic notch, flared metaphyses
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Thanatophoric dwarfism
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narrow chest, telephone receiver femurs with prominent spur of the inner proximal femur, platyspondyly, metaphyseal flaring/widening, small foramen magnum, short wide fingers. Look like homozygous achondroplasia, so check if both parents have achondroplasia
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Osteogenesis imperfecta (congenita)
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osteopenia, multiple fractures, wormian bones, exuberant callus, accordion shape femurs, platyspondyly. The differential includes child abuse, steroid osteoporosis, juvenile osteoporosis
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Hypophosphatasia
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osteopenia, lucent skull, scooped out metaphyses
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Hurler’s disease
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J-shaped sella, beaked vertebrae (inferior), posterior vertebral scalloping, thick phalanges, tapered proximal metacarpals, Madelung deformity, flared iliac wings, wide acetabular roof
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Moroqio’s disease
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vertebra plana, beaked vertebrae (middle), hypoplastic dens, short wide phalanges, tapered proximal metacarpals, flat femoral epiphyses, flared iliac wings, wide acetabular roof
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Rhizomelia ddx
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achondroplasia (AD, sporadic), thanatophoric dwarfism
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Mesomelia ddx
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middle, e.g., bones of the forearm or lower leg
mesomelic dwarfism, Cornelia de Lange syndrome |
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Acromelia
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asphyxiating thoracic dystrophy, chondroectodermal dysplasia (Ellis van Creveld syndrome), acrodysostosis
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Neurogenic tumors
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Peripheral nerve: schwannoma, neurofibroma, sarcoma
Sympathetic ganglia: ganglioneuroma, ganglioneuroblastoma, neuroblastoma Paraganglia: pheochromocytoma, glomus tumor |
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Target appearance
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neurofibroma secondary to myxoid degeneration (increased T1, decreased T2). A ganglion occurs in the superior/posterior aspect of the shoulder in the spinoglenoid notch
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Grades of ligamentous SPRAINS
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1: perifascial edema/hemorrhage
2: partial tear (increased T2 signal) 3: complete tear (increased T2 signal with disruption) |
