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Radiology 1 Final Unit
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146
Anatomy
Graduate
05/19/2011

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Term
CATBITES
Definition
Congenital
Arthritis
Trauma
Blood (hematological)
Infection
Tumor
Endocrine, Nutritional, Metabolic
Soft tissue
Term
Avascular Necrosis
Definition
Death of osseous cellular and marrow composition of bones.
Epiphyseal predisposition
Term
AVN
etiologies
Definition
Most common: spontaneous/idiopathic
Other common: alcoholism, corticosteroid
Term
PLASTICRAGS
Definition
Pancreatitis, Pregnancy
Legg-Perthes disease, Lupus
Alchoholism, Atherosclerosis
Steroids
Trauma
Idiopathic (Legg-Perthes disease), Infection
Caisson disease, Collagen disease
Rheumatoid arthritis, Radiation treatment
Amyloid
Gaucher disease
Sickle cell disease/spontaneous
Term
AVN
Pathogenesis
Definition
Blood vessels are obstructed.
Increased marrow space pressure
Time from initial infarct to healed 2-8 years
Term
AVN
4 stages
Definition
Avascular (most severe)
Revascularization
Repair
Deformity
Term
AVN
Avascular phase
Definition
Epiphyseal blood supply sucks, leading to death of osteocyte and bone marrow cells.
Growth is altered; epiphyseal growth slows or stops, articular cartilage continues
Term
Revascularization Phase
Definition
1. New Vessels grow into the necrotic bone, resulting in deposition and resorption.
2. New Bone is deposited directly on the dead bone, thickening the trabeculation and increasing bone density
3. New bone easily modeled relative to epiphyseal stresses (softer than normal)
4. Fracture under the articular cortex may occur (cresent sign)
5. Resorption is secondary to phagocytosis, fibrosis, and infiltration and produces bony fragmentation
Term
AVN
Repair and remodeling phase
Definition
Bony resoprption is replaced by bony deposition
New bone is still easily modeled and deformity may be produced.
Term
AVN
Deformity Phase
Definition
Restitution of the epiphysis to its normal configuration, occurs in varying degrees
Residual deformity is due to how much compressive force is exerted on the necrotic bone during revascularization and repair phases
Term
Epiphyseal Infarction
General Radiological Features
Definition
Collapse of articular cortex
Fragmentation
Mottled trabecular pattern
Sclerosis
Subchondral cysts
Crescent sign
Term
Epiphyseal Infarction
Collapse of articular cortex
Definition
generally at the region of max stress
Term
Epiphyseal Infarction
Fragmentation
Definition
manifestation of resorption and weakening. Radiolucent clefts appear
Term
Mottled Trabecular pattern
Definition
Reveals a thickened irregular pattern traversing necrotic areas.
Most likely seen during revascularization and repair phases
Term
Epiphyseal Infarction
Sclerosis
Definition
Occurs with revascularization
Term
Epiphyseal Infarction
Subchondral cysts
Definition
Patchy, well circumscribed areas of rarefaction identical to DJD cysts
Term
Epiphyseal Infarction
Subchondral Fractures
Definition
Results from weakened subchondral bone.
AKA Rim sign, Crescent sign
Term
Metaphyseal/Diaphyseal Infarcts
Definition
Usually medullary
Necrotic bone seen on revascularization seen as area of rerfaction (blackening)
Longer than wide
Term
AVN (adult femoral head)
Definition
Chandlers' disease
4:1 Male dominance
Bilateral, but asymetric 50% of the time
Vague symptoms: pain in the butt, groin, knee, thigh, or hip
Gradual increase in pain and decreased motion.
Limping gate
Necrotic area tends to be wedged or semilunar shaped (bite sign)
Term
Core Decompression
Definition
AVN (adult femoral head) treatment
Remove core of bone from femoral neck and head.
Reduces marrow pressure and vascular perfusion and promotes healing?
Term
Signs of avascular necrosis
Definition
snowcap sign
crescent/rim sign
mushroom deformity
hanging rope sign
Bite sign
Term
Healed AVN
Definition
May have:
Articular deformity
Early DJD
Acetabular displasia
Hanging rope sign
Trochanteric overgrowth
Term
AVN-MRI
Definition
MRI scans demonstrate a loss of marrow signal, particularly on T1 weighted scan
Often bilateral
Demonstrate joint efusion
Term
Legg-Calve-Perthes disease
Definition
AVN of the femoral capital epiphysis before closure
Self limiting (2-8 years)
Patients 4-8 years of age
Term
Legg-Calve-Perthes disease
Avascular Stage
Definition
Capsular distortion, increased joint space, increased TDD, small epiphysis
Term
Legg-Calve-Perthes disease
Revascularization
Definition
Flattened,small epiphysis, fragmentation, homogenous sclerosis (snow cap), increased cortical density, metaphyseal cysts, patchy schlerosis, crescent sign, wide short neck
Term
Legg-Calve-Perthes disease
Repair and remodeling
Definition
reconstruction of density and configuration
Coxa vera
enlarged femoral head (coxa magna)
Flattened head (mushroom deformity)
large greater trochanter
Term
Legg-Calve-Perthes disease
Radiologic Findings
Definition
Soft tissue swelling
small epiphysis
lateral displacement of ossification ctr
flattening, fissuring and fracturing of ossification center
Metaphyseal widening and foreshortened
Widened irregular physis
Intrapiphyseal gas
Term
Soft tissue signs of hip joint disease
Definition
Capsular swelling
Small obturator (hip flexion)
Increased tear drop distance
Term
Legg-Calve-Perthes disease
Prognosis
Definition
Depends on:
early diagnosis (poorer in advanced disease)
Age (younger better)
Sex (poorer in females)
Term
Osteochondrosis dissecans
Definition
Represents a focal subchondral infarction of subarticular bone
Necrotic bone may heal spontaneously or become a free floating fragment
Term
Osteochondrosis dessicans
Clinical
Definition
Children and adolecents
Males more prevelent
Unually in the knee
assymptomatic
clicking, locking, limitation of motion
swelling, pain aggravated by movement
Predisposes to DJD
Term
Osteochondritis dissecans
Location
Definition
Knee!
Medial Femoral Condyle (85%) bilateral 20-30%)
humeral head
Capitullum of elbow
talus
Term
Osteochondritis dissecans
Radiology
Definition
lesion at the lateral aspect of the medial femoral condyle
Joint mouse (osteiochondral fragment)
Soft tissue swelling
Term
Spontaneous osteonecrosis
Definition
Diagnostic term applied to the aged knee
associated with medial meniscal lesions. Black triangles
Term
Osgood Schlatter's Disease
Definition
Fragmentation of the apophysis of the tibial tuberosity
11-15 years of age
Self limiting, painful
Pain, tenderness, soft tissue swelling over tibial tubercle
Term
Freiberg's Disease
Definition
Avascular necrosis (usually the MTP 2)
More common in females (high heel shoes)
Term
Kienbock's Disease
Definition
Avascular necrosis of lunate
Associated with manual labor
20-40 year olds
75% have short ulna (ulna minus)
pain and swelling of wrist
Lunate increases density-fragments and collapses
sclerosis, radiolucent, flattening
Precipitates DJD
Term
Kohler's Disease
Definition
Tarsal Navicular
Vascular insufficiency or normal variant?
Navicular patchy, homogenous sclerosis, collapse fragmentation.
Term
Scheuermann's Disease
Definition
AKA Juvenile discogenic disease JDD
abnormality of the discovertebral junction
Probably does not represent a necrosis
Usually in teens
Chronic back pain, deformity, early DDD
Etiology: failure of embryologic vascular channels, centrum defects, and notochord clefts
Term
JDD
Radiology
Definition
T and L
3 contiguous vertebra
5 degree anterior body wedging
Increased Kyphosis
Schmorl's nodes
Term
Severs Disease
Definition
Not a necrosis!
Sclerosis and fragmentation of the calcaneal apophysis represents normal anatomy
Term
Calcified medullary infarct
Definition
Serpiginous regions of calcification within the bone medula
Associated with arteriosclerosis
Differential Diagnosis: tumor,(enchondroma (no symptoms) chondrosarcoma (pain))
Term
Sickle cell anemia
Definition
Hemolytic anemia
Pain and swelling in hands and feet
Infarct of bowel
Osseous changes related to infarction, avascular necrosis, marrowhyperplasia, and retarted growth
Predisposition to salmonella osteomyelitis
Term
Sickle cell anemia
Radiology
Definition
Marrow hyperplasia
Osteopenia
Hair on end skull
H shaped vertebrae (lincoln log)
Avascular necrosis
Term
Thalassemia
Definition
AKA Cooley's anemia
RBC blood disorders
Abnormal hemoglobin
Fatigue (chronic anemia), gallstones, cardiomegaly, splenomegaly
Features: Marrow hyperplasia, extramedullary hematopoiesis, maxillary overgrowth ("rodent facies") "hair on end skull"
Coarsened trabeculation (honeybomb)
Osteopenia
Erlenmyer flask deformity
Term
Hemophilia
Background
Definition
X chromosome linked bleeding disorder
Female the carrier usually manifest in males
Term
Hemophilia
Imaging
Definition
Intra-articular soft tissue swelling, radiodense effusion, osteopenia, square femoral condyles, degeneration, epiphyseal overgrowth, erosions, wide intercondylar nitch, irregular articular surfaces
Term
Hemophilia
Clinical
Definition
joint pain/hemophilic arthropathy
Term
Leukemia
Background
Definition
malignant proliferation of WBC
Term
Leukemia
Imaging
Definition
Radiolucent submetaphyseal bands
Osteopenia
Osteolytic destruction of long bone metaphysis and diaphysis
Periosteal reactions
Growth arrest lines
Term
Leukemia
clinical
Definition
feve, malaise, joint pain, easily bruised, spontaneous bleeds
Term
Cellulitis
Definition
Infection of skin, subcutaneous fat, or connective tissue (tendons/ligaments/muscle)
Term
Osteomyelitis
Definition
Infection of bone (marrow spaces)
Term
Musculoskeletal Infections
At risk groups
Definition
Immunosupressed
Diabetics
Post-surgical
vascular infection
Sickle-cell anemia
IV drug users
Anyone under the right conditions
Term
Drug Addicts
Definition
Prone to infections by unusual organisms at unusual sites:
"the S joints" Spine, sacroiliacs, symphysis pubis, sternoclavicular
Term
Muskuloskeletal Infections
Organisms
Definition
Staphylococcus Aureus (90%)
Mycobacterium Tuberculosis
Neisseria Gonorrhea
Pseudomonas
Fungus
Streptococcus pyogenes
Term
Modes of Infection
Definition
Trauma/Post surgical
Urinary tract infaction
Pneumonia
Skin Infections
Open wound of cellulitis
Heel sticks in infants
Term
Routes of dissemination
Definition
Hematogenous*
Direct extension
Direct implantation
Postoperative
Term
Growth plates inhibit:
Definition
Hematogenous spread.
Blood vessels do not penetrate physis in children, preventing epiphysis and joint infection. Adults and infants are succeptable.
Term
Most common locations for Infection
Definition
Knee
Hip
Ankle (distal tibia)
shoulder
Spine
Term
2 categories of infection
Definition
Suppurative (pus)
staph
Non-Suppurative (TB)
Term
Suppurative Osteomyellitis
Definition
Bone marrow infection (by anything but TB)
Term
Supperative Osteomyelitis
clinical features of acute Infection
Definition
Edema
Lymphadenopathy
Warm skin
Cellulitis
Joint Pain
Term
Suppurative Osteomyelitis
4 Radiographic Stages
Definition
Latent (hidden) Stage (1-10 days)
Early Stage (10-21 days)
Middle Stage (weeks)
Late Stage (months)
Term
Suppurative Osteomyelitis
Early Stage
Definition
Radiographic Stage>10days
Spinal lesion may approach 3 weeks
Soft tissue edema
Osteopenia
Term
Suppurative Osteomyelitis
Middle Stage
Definition
Permeative or Lytic moth-eaten destruction
Periosteal response; solid, laminated, codman's triangle
Term
Suppurative Osteomyelitis
Late Stage
Definition
Cortical destruction
Draining sinus
Involucrun
Cloaca
Sequestrum
Sclerosis
Debris
Loss of joint space
Ankylosis
Term
Sequestrum
Definition
Chalky, white area: isolated dead bone
Cortical and medullar infactrs
Term
Involucrum
Definition
"Bony collar"
Chronic periosteal response
Pus lifts the periosteum and causes new bone formation, trying to wall off the infection.
Term
Cloaca
Definition
Draining sinus
More common with chronic disease
Rare complication is to develop a squamous cell carcinoma within the channel of the cloaca; the ulcerative channel with malignant transformation has been called Marjolin's Ulcer
Term
Brodie's Abscess Formation
Definition
Localized, abortive form of supperative osteomyelitis
Localized pain that worsens at night
Lesions may be sterile
Chronic osteomyelitis
Reactive sclerosis
Term
Spinal Infections
Definition
<20 years of age: disc is still vascular, if begins there it spreads to adjacent bodies
Adult: Starts in Anterior Vertebral Endplates, then goes to disc with vertebral collapse
Lumbar most common
Term
Septic Arthritis
Definition
Joint Effusion
Juxtaarticular osteoporosis
Lytic destruction that crosses the joint space
Term
Normal teardrop Distance
Definition
9-11 mm
Term
Unilateral sacroilitis?
Definition
Think Infection
Term
Spine infection
Early radiographic features
Definition
rapid disc space loss
Endplate destruction
Term
Spine Infection
Radiographic Features
Definition
Endplate destruction
Disc destruction
Pre-vertebral ST swelling
SOL
Term
LImitations of Plain Films
Definition
Not very sensitive
Must have significant loss in bone density before it is detected
Other imaging studies are better for detection of early infection.
Term
Sensitivity of Plain Films for osteomyelitis
Definition
<5% are abnormal on presentation
<33% are positive for findings at 1 week
90% sensitivity at 3-4 weeks
Term
Bone Scintigraphy
Definition
Can detect infection within hours of infection.
Utilizes Technetium (non specific)
Galium tags RBC
Indium tags WBC
Very sensitive
Often followed by MRI to evaluate soft tissue
Term
Computed Tomography
Definition
Advantages: earlier detection than plain film
Good for hard to see image areas (spine, pelvis, sternum)
Findings are more specific and suggestive for osteomyelitis
Increased marrow density
Sclerosis, demineralization, periosteal reaction
Term
MRI and Infection
Definition
Better than CT and Plain Film
More sensitive for bone marrow paths
Direct view of intramedullary disorders
May precede bone scan findings
Multiple slices visualized
Better soft tissue contrast
Better anatomic definition
Term
Osteomyelitis findings on MRI
Definition
Decreased signal intensity on T1
Increased signal intensity on T2
Term
Suppurative Osteomyelitis
Key Points
Definition
Main Cause: Staph Aureus
Radiographic latency period of 10 days
Lytic destruction of bone that crosses anatomical barriers (vs. tumor)
Joint/extremity involvement classic
Disc space loss with endplate destruction classic in the spine
Effective treatment requires early diagnosis
Term
Tuberculosis
Definition
Nonsuppurative osteomyelitis (Pott's disease)
Main cause of infection related death worldwide.
Term
TB
Skeletal Involvement
Definition
1-3% of TB cases
Usually involves weight bearing joints
Secondary form of TB
Term
TB
Radiographic features
Definition
Typically begins in anterior endplate region
Disc space narrowing=earliest radiographic finding
Vertebral collapse
Decreased T1 and increased T2
Term
TB
Comparison to osteomyelitis
Definition
Similar, but add: Multiple levels
Paraspinal cold abcesses with Ca+
Term
TB (non suppurative)
Comparison to Suppurative
Definition
similar, but much slower and indolent
Term
Phemister's triad
Definition
Sign of Tuberculosis Septic Arthritis
Juxtarticular osteoporosis
Marginal erosions
Slow joint space loss
Term
Hormones inhibiting bone production
Definition
Parathyroid hormone (PTH)
Cortisol
Term
Hormones and nutrients that stimulate bone production
Definition
Growth hormone
Thyroid hormone
Calcitonin
Vitamin D
Vitamin C
Term
Osteopenia
Definition
All encompassing definition for increased radiolucency of bone.
Many etiologies
Term
Plain film detection of osteopenia
Definition
30-50% of bone mass loss needed before it can be detected on pain film
Term
Osteoporosis
Definition
Qualitatively normal but quantitatavely deficient bone.
Gradual reduction in skeletal mass
Compression fractures
Increasing thoracic kyphosis
Term
Primary oseoporosis
Definition
Senile osteoporosis
Postmenopausal
transient/regional osteoporosis
Term
Secondary osteoperosis
Definition
corticosteroids
Infection
Disuse
RDS
Arthritides
Term
Osteoporosis
MR
Definition
Allows early diagnosis of fracture.
Term
Risk factors for osteoporosis
Definition
Female sex
Early onset of menopause
Inactivity
Smoking
Alchohol
Caffeine
Excessive protein
Low calcium intake
No sunlight or vitamin D
Term
Osteoporosis
Radiographic features (spine)
Definition
Osteopenia and radiolucenc
Cortical thinning "pencil thin"
Wedge shaped vertebrae
codfish deformity
Schmorl's nodes
Term
Osteoporosis
In extremity
Definition
Thinned cortices
Endosteal scalloping
Loss of secondary trabeculae
Risks of fractures
Term
Ward's triangle
Definition
Compressive and tensile trabeculae at head of femur. Strong.
Term
Pathological causes of osteoporosis/osteopenia
Definition
plasma cell (multiple) myeloma
metastasis
anemia
nutritional deficiencies
diabetes mellitus
immunodeficiency states
chronic liver disease
Term
Multiple myeloma
Definition
Osteopenia (esp. in patient too young for osteoporosis)
Compression fractures
Punched out lesions
Term
Dual Energy X-ray Absorptiometry
Definition
DEXA scan
Evaluate osteoporosis
low energy x-rays measure mineral content of bone
Determined Bone Mineral Density
Term
T-Score
Definition
Predicts fracture risk.
For every -1 SD the risk doubles
0=normal risk for 40 year old
-1 for about every -10% of bone loss
Term
WHO defines oseoporosis on basis of:
Definition
T-scores
below -2.5=osteoporosis
Term
Regional osteoporosis
Definition
Immobility and disuse
Reflex sympathetic dystrophy syndrome
Term
Disuse osteoporis
Definition
Inhibits osteoblast activity
Term
RSD
Definition
Reflex sympathetic dystrophy syndrome
Acute pain following trivial trauma.
Especialy hand
Reflex hyperactivity of the SNS
Skin atrophy
pigmentation abnormalities
Term
RSD
Imaging
Definition
Too nonspecific to make the diagnosis without clinical information.
Soft tissue swelling
regional osteoporosis
Joints are OK
Osteoporosis may be patchy
Term
Transient osteoporosis of the hip
Definition
Middle aged adults
May be related to pregnancy
More common in men and usually bilateral in men
left hip usually involved in women.
Joint space remains normal
Decreased T1, Increased T2
Self limiting over 3-12 months
Term
Osteomalacia
Definition
Altered bone quality
Lack of calcium
High ratio of osteoid
Term
Osteomalacia
2 main causes
Definition
Vitamin D deficiency
Renal tubular phosphate loss (Fanconi's syndrome)
Term
Rickets
Definition
Childhood osteomalacia
Term
Osteomalacia
Radiology
Definition
Osteopenia (less dense)
Coarsened trabeculation (thicker)
Looser zones (pseudofractures)
Basilar invagination
Acetabular protrusion.
Term
Best diagnostic procedure for osteomalacia
Definition
bone biopsy
Term
Rickets
Radiography
Definition
"Rachitic rosary" of chest due to cartilage overgrowth
Paintbrush metaphysis
Bow legs
Term
Scurvy
Definition
Barlow's disease
Long term deficiency of Vit C
Capillary fragility
Mistaken for child abuse
osteopenic bones
Term
Scurvy radiological features
Definition
Osteopenia
Widened mataphysis
Beak like metaphyseal outgrowths (Pelken's spurs)
Wimberger's sign
Scorbutic zone
Term
Wimbergers sign
Definition
sign of scurvy
Radiodence slcerosis around epiphysis, rediolucent centrally
Term
Scorbutic zone
Definition
radiolucent band visible directly beneath zone of provisional calcification.
Term
Primary
Hyperparathyroidism
Definition
Parathyroid gland adenoma
Most common type
Major cause of hypercalcemia
Term
Secondary hyperparathyroidism
Definition
Compliation of chronic renal disease
Stimulates PTH release
Term
Tertiary HPT
Definition
Seen in dialysis patients.
Term
HPT
radiography
Definition
Osteopenia
Suboperiosteal Resorption
Brown tumors
Soft tissue calcification
Term
Subperiosteal resorption
Definition
Most definitive radiographic sign of HPT
Esp at radial margins middle and proximal phalanges of the 2nd and 3rd digits
Widened SI joints
Term
HPT Axial skeleton
Definition
Rugger jersey spine
Subperiosteal resorption at SI joints
Salt and pepper skull
Term
Brown tumor
Definition
feature of HPT
Hemorage causes hemosiderin producing brown color
Term
Renal osteodystrophy
Definition
Bone disorder occuring when the kidneys fail to maintain proper levels of calcium and phosphorus in blood.
Affects patients on dialysis
Term
% of population with small pituitary adenomas
Definition
25%
Term
Pituitary tumor
Definition
Headaches
Visiual disturbances (optic chiascm)
discomfort in extremities.
Term
Acromegaly
Definition
Oversecretion of growth hormone from pituitary adenoma.
Occurs after growth centers close
Coarse facial features
Enlarged jaw, hands, feet, head (no increase in height)
Term
Acromegaly
radiographic features
Definition
spade like distal tufts (fingers)
Heel pad thickness >23mm
Term
Hypercortisolism
Definition
AKA Cushings
MC: Exogenous corticosteroid administration
Term
Cushings
features
Definition
Obese, especially upper thorax
moon face
Buffalo hump
Purple striae on abdomen
Hypertension
Rib and vertebra fractures
Term
Cushings
Radiografic features
Definition
osteopenia
compression fractures
avascular necrosis
atherosclerotic plaquing
Term
Achondroplasia
Definition
Dwarfis
Trident hands (all fingers same length)
bullet vertebrae
Arnold Chiari malformation (skull)
Champagne glass pelvis
Term
Cleidocranial dysplasia
Definition
defect of intramembranous bone growth
Skull, clavicle, and midline defects
Inverted pear shape skull
aplasio or hypoplastic clavicles
Term
Marfan's syndrome
Definition
Collagen disorder fails to produce normal collagen
Tall stature, arachnodactly, heart valve defects, aortic aneurysm, lens dislocation
Term
Marfan's
Imaging
Definition
Scoliosis
Acetabular protrusion
Pectus excavatum
Term
Osetogenesis Imperfectica
Definition
Type 1 collogen disorder
skeletal fragility
may be lethal at birth
Confused with abuse
Blue sclera
abnormal dentition (rotten teath)
Premature otosclerosis (earbone thickening)
Term
Osteogenesis Imperfectica
Imaging
Definition
Osteopenia
Bowed long bones
Thin corticles
Multiple fractures
Kyphoscoliosis
Term
Osteopetrosis
Definition
Sclerosing bone disease (more white)
Decreased osteoclast activity
Term
Osteopetrosis
Imaging
Definition
Bone within bone "endobone, sandwich vertebra"
Erlenmeyer flask deformity
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