Musculoskeletal imaging

Question 1

Multiple lytic lesions

Answer 1

Metastases
Myeloma
LCH
Lymphoma
FD
CRMO/SAPHO ?HLAB27/?p.acnes ( I confuse this with transient osteoporosis of the hip)

Question 2

Sequestrum

Answer 2

EFILM
EG
Fibrosarcoma
Infection
Lymphoma
Malignant fibrous histiocytoma (PUS)
mimic: osteoid osteoma

Question 3

Newborn with periosteal reaction

Answer 3

Physiologic: medial tibia, 1-6 months, bilateral, diaphyseal
Caffey: bearded infant - mandible, clavicles and long bones, systemic symptoms, self limiting by 6-9/12
Antenatal TORCH infection e.g. wimberger corner in syphilis, celery stalk in congenital syphilis/CMV/rubella
Prostaglandin treatment
(also Neuroblastoma mets, LCH, NAI)

Question 4

Rugger Jersey spine

Answer 4

renal osteodystrophy/hyperparathyroidism

Differentials:
Picture frame: pagets
Sandwich: osteopetrosis

Ivory:
Lymphoma, Infecion (Tb), met/myeloma, Pagets

Osteoblastic mets: ewings/medulloblastoma/neuroblastoma, prostate/breast

Question 5

Sacroiliitis

Answer 5

Psoriatic arthritis and reiters are asymmetric or symmetric
ankylosing spondylitis and IBD related arthropathy are symmetric
If symmetric also consider RA
If asymmetric consider OA and gout
If unilateral consider infection

mimic: osteitis condensans ilii

Question 6

MCPJ arthropathy

Answer 6

Rheumatoid
CPPD
Haemochromatosis
Gout
SLE

Question 7

IPJ arthropathy

Answer 7

Erosive OA
Psoriatic arthropathy
OA

Reactive arthritis
Rheumatoid arthritis

“licked candy” leprosy/psoriatic/neuropathic/rheumatoid

Question 8

Erosive arthropathy of foot

Answer 8

Gout
Rheumatoid
Reactive/psoriatic

Question 9

Distal clavicle erosion

Answer 9

SHIRT

Scleroderma
Hyperparathyroidism: also erosion CC insertion
Infection
Rheumatoid
Trauma: stress osteolysis

Mets/myeloma

Question 10

Vertebra planar

Answer 10

infection (Tb)
Mets/myeloma
EG
Lymphoma/leukaemia
Trauma

Question 11

Wormain bones

Answer 11

OI
cleidocranial dysostosis
T21
Metabolic: hypothyroid/rickets

Question 12

Madelung

Answer 12

Idiopathic
Turners, Ollier, multiple hereditary exostoses
Post-traumatic: gymnasts

Question 13

Osseous lesion with fluid fluid levels

Answer 13

ABC

Telangectatic osteosarcoma

Question 14

Chondroid lesion

Answer 14

enchondroma
chondrosarcoma
bone infarct

Question 15

Acro-osteolysis

Answer 15

Psoriasis
Injury - hypothermia or burns
Neuropathic - diabetes and leprosy
CVD- scleroderma
Hyperparathyroidism
Familial - Hajdu Cheney
Other: PVC

Band: CHFO only

Question 16

Diffusely increased bone density

Answer 16

Mets
Metabolic: renal osteodystrophy/fluoride
Myelofibrosis
Mastocytosis
Ostepetrosis
Pagets

Question 17

Loose bodies

Answer 17

Rice bodies
Lipoma aborescens
PVNS
osteochondromatosis

Question 18

Rib lesion

Answer 18

FAME

FD
ABC
Met/myeloma
Ewings/EG/Enchondroma

Question 19

Posterior element lytic lesion

Answer 19

ABC
Osteoblastoma/osteoid osteoma
Infection (Tb)
Met
LCH

Vertebral lesion:
non neoplastic: ABC/heamangioma
Metastasis
Primary:
myeloma/plasmacytoma
osteoid osteoma/osteoblastoma
chordoma
chondrosarcoma/osteosarcoma
ewings
lymphoma
GCT
LCH

Classic for PE: ABC/osteoid osteoma/osteoblastoma

Question 20

Ivory vertebral body

Answer 20

Lymphoma
Infection - Tb
Met: NB/MB/breast/prostate
Pagets

Question 21

Periarticular soft tissue calcifications

Answer 21

Gout
Myositis ossificans
Metastatic calcification in renal failure
Tumoral calcinosis
Scleroderma
soft tissue sarcoma

Calcinosis Universalis:
SLE/scleroderma/polymyositis/dermatomyositis

Question 22

Benign expansile lytic lesion

Answer 22

SBC/ABC
GCT
FD
EG

Question 23

Multiple sclerotic foci (in Pelvis)

Answer 23

Mets
osteopoikilosis
pagets

Question 24

Vertebral body wedge fracture

Answer 24

trauma
Insufficiency
pathologic - abnormal signal ill defined, extends into posterior elements, enhances, soft tissue lesion

Question 25

Epiphyseal lucent lesion

Answer 25

ABC
Infection
GCT
Chondroblastoma (Clear cell chondrosarcoma)