Chapter 46 - Miscellaneous Bone Lesions (CHERI Notes) Flashcards Preview

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Flashcards in Chapter 46 - Miscellaneous Bone Lesions (CHERI Notes) Deck (29)
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1
Q

The most common cause of dwarfism is ___. A congenital hereditary disease of failure of endochondral bone formation.(p.1090)

A

ACHONDROPLASIA

  • the FEMURS and HUMERI are more profoundly affected than the other long bones; although the entire skeleton is abnormal.
2
Q

DIAGNOSIS?
Characteristic finding is that the spine typically has narrowing of the interpeduncular distances in a caudal direction. (p.1090)

A

ACHONDROPLASIA

  • the opposite of normal; in which the interpeduncular distances get progressively wider as one proceeds down the spine.
  • the long bones are short but have normal width; giving them a thick appearance.
3
Q

The term______ refers to the lack of blood supply with subsequent bone death and ensuing bony collapse in an articular surface. (p.1090)

A

AVASCULAR NECROSIS (AVN) or OSTEONECROSIS

  • the etiology of AVN is an extensive differential that most commonly includes trauma; steroids; aspirin; renal disease; collagen vascular diseases; alcoholism and idiopathic causes.
  • radiographic appearances range from PATCHY SCLEROSIS to ARTICULAR SURFACE COLLAPSE AND FRAGMENTATION.
4
Q

Late and inconstant sign of AVN. (p.1090)

A

Just before collapse; a subchondral lucency is occasionally seen.

5
Q

___ is extremely valuable in demonstrating the presence and extent of AVN; even when plain films are apparently normal. (p.1090)

A

MR

  • considered to be the most efficacious way to evaluate a joint for AVN.
  • it is useful not only in AVN of the hip but also in the knee; wrist; foot and ankle.
6
Q

_____ OSTEOARTHROPATHY is manifested by clubbing of the fingers and periostitis; usually in the upper and lower extremities.; which might or might not be associated with bone pain. (p.1090)

A

HYPERTROPHIC PULMONARY OSTEROARTHROPATHY

  • It is most commonly seen in patients with LUNG CANCER; but many other etiologies have been reported; including bronchiectasis;
    GI disorders and liver disease.
7
Q

The differential diagnosis for periostitis in a long bone without an underlying bony abnormality would include ____. (GIVE 6). (p.1090)

A
  1. Hypertrophic pulmonary osteoarthropathy
  2. Osteoarthropathy
  3. Venous Stasis
  4. Thyroid acropachy
  5. Pachydermoperiostosis
  6. Trauma
8
Q

_____ is a rare; idiopathic disorder characterized by thickened cortical new bone that accumulates near the ends of long bones; usually only on one side of the bone; and has an appearance likened to “DRIPPING CANDLE WAX”. (p.1090)

A

MELORHEOSTOSIS

  • It can affect several adjacent bones and can be symptomatic
9
Q

The _____ are a group inherited diseases characterized by abnormal storage and excretion in the urine of various mucopolysaccharidoses
such as keratin sulfate (____) and heparan sulfate (______). (p.1090)

A

MUCOPOLYSACCHARIDOSES;
MORQUIO; HURLER

  • these patients have short stature; primarily from shortened spines;
    and characteristic plain film findings
  • the pelvis in this disorders is similar in appearance to that of achondroplasts; with wide; flared iliac wings and broad femoral necks.
10
Q

In the spine; patients with ______ have platyspondyly (generalized flattening of the vertebral bodies) with a central anterior projection or “beak” off the vertebral body;
as viewed on a lateral plain film. (p.1091)

A

MORQUIO

11
Q

______ show platyspondyly with a beak that is anteroinferiorly positioned. (p.1091)

A

HURLER AND HUNTER

12
Q

A characteristic finding in the hands

in MUCOPOLYSACCHARIDOSES) is a _____. (p.1091

A

POINTED PROXIMAL FIFTH METACARPAL BASE THAT HAS NOTCHED APPEARANCE TO THE ULNAR ASPECT.

13
Q

_____; also known as DIAPHYSEAL ACLASIA; that
is a not uncommon hereditary disorder that seems to affect multiple members of a family with multiple osteochondromas or exostoses.(p.1092)

A

MULTIPLE HEREDITARY EXOSTOSIS

  • the KNEES are virtually always involved
  • under tubulation (a widened diameter of the bone) is invariably present at the site of exostosis.
  • the incidence of malignant degeneration in this population has been reported to be as high as 20%; but this is a gross overestimation;
    with malignant degeneration being extremely rare.
14
Q

An ______ is a cartilage-capped bone outgrowth that may be pedunculated or sessile in appearance. (p.1092)

A

OSTEOCHONDROMA

15
Q

As with SOLITARY OSTEOCHONDROMAS;
the more ____-situated lesions are more prone to undergo malignant degeneration; whereas the more peripheral lesions are less likely to do so. (p._____)

A

AXIALLY-situated

  • The proximal femurs are frequently involved and have a characteristic appearance
16
Q

DIAGNOSIS? (p.1092)
The classically described radiographic appearance is cortically based sclerotic lesion in a long bone that has a small lucency within it that is called the NIDUS.

A

OSTEOID OSTEOMA

  • The etiology of osteoid osteroma is unknown.
  • It is a painful lesion that occurs almost exclusively in patients less
    than 30 years of age and is treated successfully with surgical excision
    or thermal ablation
17
Q

It is the ____ that causes the pain and the surrounding reactive sclerosis in OSTEOID OSTEOMA. (p.1092)

A

NIDUS

  • if the nidus is surgically removed or thermally ablated; complete cessation of pain is the rule.
  • CT is often very helpful in the demonstrating (of OSTEOID OSTEOMA) the exact location or the nidus.
18
Q

TRUE OR FALSE?
(in OSTEOID OSTEOMA) (p.1092)
- If the nidus of an osteroid osteoma is located in the medullary rather than the cortical portion of a bone; or if it is located in a joint; there is much less reactive sclerosis present.

A

TRUE

  • this gives the lesion a different overall appearance than the more common cortical lesion in that it does not appear as sclerotic.
19
Q

Up to 80% of OSTEOID OSTEOMAS; are located _____. (p.1093)

A

INTRACORTICALLY;

  • with the remainder being in the INTRAMEDULLARY part of a bone.
  • rarely; an osteoid osteoma will be present in the periosteum; causing exuberant periostitis
20
Q

TRUE OR FALSE? (In OSTEOID OSTEOMA)

- The nidus itself is usually lucent but often develops some calcification within it.

A

TRUE

  • It then has the appearance of a sequestrum; as seen in OSTEOMYELITIS.
  • if the nidus calcifies completely; it blends in with the surrounding sclerosis and cannot be seen on most radiographs.
  • Therefore; the diagnosis of an osteoid osteoma in no way depends on seeing a nidus.
21
Q

TRUE OR FALSE?
Because an osteoid osteoma resembles osteomyelitis; regardless of the appearance of the nidus; it can be difficult to differentiate two radiographically. (p.1094)

A

TRUE

  • it cannot be reliably done with plain films; CT or MR
  • because the nidus is extremely vascular; it avidly
    accumulates radipharmaceutical bone-scanning agents.
  • an osteoid osteoma will have an area of increased
    uptake corresponding to the area of reactive sclerosis but; in addition; will demonstrate a second area of increased uptake corresponding to the nidus (DOUBLE-DENSITY SIGN)
22
Q

TRUE OR FALSE.
Osteomyelitis has a photopenic area corresponding to the plain film lucency that represents an avascular focus of purulent material. (p.1094-1095)

A

TRUE

  • The natural history of an osteoid osteoma is presumed to be spontaneous regression; as they are rarely seen in patients older than the age of 30.
23
Q

______ (aka ________disease); this disorder is manifested by multiple 2-to 3 mm- thick linear bands of sclerotic bone signed parallel to the long axis of a bone.(p.1095)

A

OSTEOPATHIA STRIATA
(aka VOORHOEVE DISEASE)

  • It usually affects multiple long bones and is asymptomatic; hence; it is usually an incidental finding.
24
Q

_________ is a hereditary; asymptomatic disorder that is usually an incidental finding of multiple small (3 to 10 mm) sclerotic bone densities affecting primarily the ends of long bones and
the pelvis. (p.1095)

A

OSTEOPOIKOLOSIS

  • It has no clinical significance other than it can be confused for diffuse osteoblastic metastases.
25
Q

______ is a rare familial disease that is manifested by thickening of the skin of the extremities and face; clubbing of the fingers; and widespread periostitis (p.1096)

A

PACHYDERMOPERIOSTOSIS

  • seem to be more common in black patients
  • the periosteal reaction is similar to that of hypertrophic pulmonary osteroarthropathy; but pachydermoperiostitis is only occasionally painful.
26
Q

______ is a noncaseating granulomatous disease that primarily affects the lungs.
- causes a characteristic LACELIKE PATTERN of bony destruction in the hands. (p.1097)

A

SARCOIDOSIS

  • when the musculoskeletal system is involved; the HANDS are mainly affected; with the spine and long bones only infrequently involved.
  • Multiple phalanges are typically affected in either one or both hands.
  • it is so radiographically characteristic that there is almost no differential diagnosis for this pattern.
27
Q

______ (aka ____); this poorly understood disorder is an idiopathic process that begins with a painful hip with no underlying disorder or other findings other than osteroporosis; which
is limited to the painful hip. (p.1097)

A

TRANSIENT OSTEOPOROSIS OF THE HIP
(IDIOPATHIC TRANSIENT OSTEOPOROSIS OF THE HIP)

  • MR findings are similar to early AVN
    T1WI: low signal seen througout the femoral head
    and neck
  • edema is typically greater than with AVN and no well-demarcated margin is present.
  • self-limited with full resolution
  • it tends to occur more often in males.
28
Q

A similar process like transient osteroporosis of the hip which occurs in the KNEE is called ____? (p.1097)

A

PAINFUL BONE MARROW SYNDROME

  • seen most commonly in the medial condyle; but can occur laterally or in the proximal tibia adjacent to the joint.
  • protected weight-bearing is recommended to prevent insufficiency fractures
29
Q

Painful bone marrow edema has been reported in the hip (ITOH); knee; distal clavicle and ankle.
It can occur in the several different locations over time or simultaneously and then is called ____. (p.1097)

A

REGIONAL MIGRATORY OSTEOPOROSIS