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Diagnostic Imaging Exam 2 > Notes > Flashcards

Notes Flashcards

1
Q

ARTHRITIDES

A

= Arthritic conditions
Over 100 different conditions

4 Categories

  1. Inflammatory
  2. Degenerative
  3. Metabolic
  4. Infection
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2
Q

Inflammatory Arthritides

A

Characteristics:

  • Soft tissue swelling, edema
  • Uniform loss of joint space
  • Erosions
  • Cystic changes: juxta-articular osteoporosis/osteopenia
  • Monoarticular or polyarticular
  • Symmetric pattern
  • Greater predisposition to fusion (ankylosis) than degenerative or metabolic
  • Ex: Rheumatoid
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3
Q

Degenerative Arthritides

A

Characteristics:

  • Non-uniform loss of joint space
  • Osteophytes
  • Subchondral clerosis
  • Cystic changes
  • Asymmetric changes
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4
Q

Metabolic Arthritides

A

characteristics:

  • Notable soft tissue masses within periarticular soft tissues
  • Well-marginated bone lesions
  • Relative preservation of joint space
  • Overlapping degenerative and inflammatory changes is common
  • “The lumpy bumpy arthritis”
  • ex: gout
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5
Q

Infectious/Septic Arthritis

A
  • Common cause of grossly destroyed and disintegrated joints
  • Gereatest incidence is below age 30
  • Monoarticular is most common
  • Caused by blood borne pathogens and direct implantation (S. aureus is most common organism)
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6
Q

Radiological Assessment of Joints (I)

A

Plain film shows bone involvement, therefore hard to detect early disease.

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7
Q

Radiological Assessment of Joints (II)

A

Radiolographic findings lag behind clinical: 30-50% of bone must be destroyed to see it on x-ray, 3% to see on bone scan (= radionuclide scintigraphy).

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8
Q

Radiological Assessment of Joints (III)

A

Parameters:

  • Clinical evaluation
  • Age and sex
  • Distribution of joint disease
  • Readiographic appearance
  • Lab tests
  • Specialized imaging exams
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9
Q

General Age of Onset

A

0-20 Juvenile rheumatoid arthritis or other juvenile arthritis

20-40 Seronegative, seropositive joint disease/spondyloarthropathy
over 40 degenerative, DISH, gout, CPPD

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10
Q

ABCDS of Joint Diseases

A 
Alignment
Bone
Cartilage (joint space)
Distribution (consider target joints)
Soft Tissues
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11
Q

Law of Parsimony

A

Taking historical points and physical findings and putting them together into one diagnosis
but patients often have more than one arthropathy.

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12
Q

ABCDS of Joint Diseases

A 
Alignment
Bone
Cartilage (joint space)
Distribution (consider target joints)
Soft Tissues
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13
Q

DEGENERATIVE ARTHRITIS

A 
Target joints are weight-bearing articulations of the:
spine
-hips
-knee
-AC joint
-1st MTP
-1st MC-trapezium
-DIP joints
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14
Q

DEGENERATIVE ARTHRITIS

A 
Although any joint can be affected)
characteristics:
-	insidious onset
-	intermittent exacerbaions
-	aching pain, stiffness 
-	aggravation of symptoms with environmental changes such as cold and drop in barometric pressure
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15
Q

Primary DJD

A

No evidence of underlying etiology

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16
Q

Secondary DJD

A

Caused by:
Abnormal forces including obesity, trauma, joint deformity
-Pre-existing cartilage pathology such as rheumatoid arthritis, fractures and meniscal damage
-Collapse of subchondral bone, such as avascular necrosis and osteoporosis

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17
Q

DJD Other names

A 
Osteoarthritis
Osteoarthritis
Degenerative joint disease
Degenerative disc disease
Spondylosis
Arthritis
Arthrosis
Kellgren’s arthritis
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18
Q

DJD Risk Factors

A
  • Increases with age
  • Females have increase in DJD of hands, kness
  • Obesity increases DJD of knees and hips
  • Trauma – most significan local factor
  • High impact physical activity increases risk
  • Increases with inactivity or excessive activity
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19
Q

DJD Clinical Features

A
  • Poor radiographic-to-clinical correlation
  • Stiffness, especially with rest
  • Normal blood work
  • Spinal stenosis
  • Vertebrobasilar ischemia
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20
Q

DJD Progression/Development

A

Abnormal articular forces promote loss of chondroitin sulfate and interfere with normal chondrocyte function, which leads to:

  • Cartilage degradation—fissures, flaking, vascularization
  • Denudation process secondary to altered joint function
  • Synovium hypertrophy
  • Cartilaginous debris
  • Osteophytes develop from cartilage metaplasia and increased capsular insertion stresses
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21
Q

DJD Radiology Features (I)

A

Enthesopathy = pathological osseous proliferation at tendon or ligament insertion; degenerative, inflammatory [enthuses=anatomical location of insertion of ligament/tendon into bone via Sharpey’s fibers]
Ankylosis (rare, but joint may look fused)

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22
Q

DJD Radiology Features (II)

A 
Asymmetric distribution
Asymmetric loss of joint space
Osteophytes at joint margin
Subchondral sclerosis
Subchondral cysts (geodes)
Subluxation
Interarticular loose bodies
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23
Q

DJD in the Hands

A

Common, especially among middle-aged postmenopausal women

osteophytes, sclerosis, loss of joint space, misalignment

24
Q

DJD in the Hands (I)

A

Bouchard’s Nodes = enlarged soft tissue nodes of PIPs

25
DJD in the Hands (II)
Heberden’s Nodes = enlarged soft tissue nodes of DIPs
26
DJD in the Hands (III)
“Gull wing” – bilateral DJD with central joint erosions; variant of the normal DJD pattern
27
DJD in the Hands (IV)
``` Ungula tuft : At distal part of distal phalanges Target Locations: -DIPs -PIPs -1st metacarpal-carpal joints -NOT MPs ```
28
DJD in the Hands (V)
Ungula tuft : At distal part of distal phalanges
29
Erosive Osteoarthritis (I)
Variant of DJD
30
Erosive Osteoarthritis (II)
Middle aged females | Appears unusually inflammatory
31
Erosive Osteoarthritis (III)
Middle aged females
32
Erosive Osteoarthritis (IV)
Appears unusually inflammatory
33
Erosive Osteoarthritis (V)
DDx: RA, psoriatic arthritis “gull-wing” DIP joints is classic radiographic finding pain, redness, swelling, decreased motion
34
DJD in the Feet (I)
1st MTP joint common
35
DJD in the Feet (II)
Hallux rigidus when present with symptoms of pain and stiffness. Metatarsus varus hallux valgus joint misalignment is common
36
DJD in the Feet (III)
Bunions – enlarged head of metatarsal with cystic changes
37
DJD in the Shoulder (I)
1. Glenohumoral joint degenerative changes usually require prior trauma Osetophytes and joint misalignment should arouse suspicion of significant previous trauma or underlying CPPD
38
DJD in the Shoulder (II)
2. Acromioclavicular joint Often involved in DJD without prior trauma Osteophytes extending inferiorly may impinge on rotator cuff tendons leading to tendon calcification and superior migration of humerus
39
Shoulder Impingement Syndrome
Rotator Cuff Arthropathy = Greater Tuberosity Enthesopathy (greater tuberosity is location of insertion of supraspinatus tendon)
40
Shoulder Impingement Syndrome
Progression: 1. Degenerative enthesopathic changes of the humeral head, especially greater tuberosity 2. Spurring (osteophytes)/erosions of acromion process 3. Humerus migrates superior due to unopposed deltoid action, no room for supraspinatus 4. Supraspinatus degeneration → rotator cuff tear: see increased signal in supraspinatus tendon on MR in the critical zone where there is less vascularity
41
HADD (I)
Hydroxyapatite Deposition Disease
42
HADD (II)
Deposition of calcium within tendons and bursa
43
HADD (III) MC areas
``` -Most commonly seen in the supraspinatus tendon then: Shoulder Elbow Wrist Hip Knee Ankle Spine ```
44
HADD (IV) AKAs
Calcifying tendinitis, calcifying bursitis, peritendinitis calcarea
45
HADD (V) Characteristics
Characteristics: pain, tenderness, localized swelling reduced range of motion -lab unrewarding -radiographic diagnosis of calcificaiton of soft tissue involved -focus of degeneration within tissue follows with hydroxyapatite crystal deposition *Disc calcification is a form of HADD due to DDD.
46
DJD of the Knee
3 compartments of the knee: - Medial tibiofemoral – most common compartment for DJD - Lateral tibiofemoral - Retropatellar
47
Characteristics of DJD in the Knee
- asymmetric loss of joint space - subchondral sclerosis - subchondral cysts - articular deformity and irreglarity - hypertrophic changes of intercondylar spines - enthesopathy of anterior (non-articular) surface of patella - genu varus in case of medial compartment degeneration
48
Synovial Osteochondrometaplasia
Multiple intra-articular loose bodies/fragments/cartilaginous masses produced by synovial tissue metaplasia (junk in the joint) may ultimately ossify/calcify to become visible radiographically—joint mice, with joint locking
49
Synovial Osteochondrometaplasia (II)
Common in the knee and also seen about the - Hip - Ankle - Shoulder - Wrist
50
Synovial Osteochondrometaplasia (III)
Seen as laminated, stippled, concentric calcific densities, unlike HADD
51
Pigmented Villonodular Synovitis (PVNS) (I)
Slow-growing, benign and locally invasive tumor/metaplasia of the synovium
52
Pigmented Villonodular Synovitis (PVNS) (II)
Most often involves the knee. Also in hip, ankle, elbow | Found in young to middle age adults - consider in younger patient with unexplained hip pain
53
Pigmented Villonodular Synovitis (PVNS) (III)
DDx: rheumatoid arthritis
54
Pigmented Villonodular Synovitis (PVNS) (IV)
Characteristics: - Intraarticular effusions, lobulated masses - Bony erosions more common in tight joints (hip, elbow, wrist) - Apple core deformity in hip – Concentric erosions o femoral neck - Seen on opposing joint surfaces
55
DJD of the HIP
Compartments of hip joint: medial, axial, superior
56
DJD of the HIP characteristics:
- loss of joint space – 80% toward the superior compartment - osteophyte formation - subchondral cysts/geodes (Eggar’s cysts) – due to intra-osseous synovial intrusion through cartilage fissures along with necrosis; subchondral with sclerotic borders; can be confused with tumor when large (do MR) - sclerosis - joint deformity - buttressing – Thickened cortex at the medial femoral neck as result of biomechanical changes across the joint

Diagnostic Imaging Exam 2 (1 decks)

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