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Flashcards in Radiography - Vicki Deck (38)
1

MR LEMONS

SMALL BLUE CELL TUMORS...

Melanoma
Rhabdomyosarcoma
Lymphoma
Ewings
Medulloblastoma
Other
Neuroblastoma
Small cell

2

32 male, multiple fractures after tripping over himself walking. Complaining of slight weakness in facial muscles and decreased hearing on left. Previous multiple fractures after minor falls. X-Ray shows lots of lucent (weak) bone.

Pathology?

Radiography?

Complication?

Osteopetrosis

Spongiosa filling the medullary canal with no trabeculae

Erlenmeyer flask of tubular bones,

Pancytopenia

3

Causes of osteonecrosis (avascular necrosis) - KNOW

Fracture
Corticosteroid use
Sickle cell
Alcoholism
Pancreatitis
Legg-Calve perthes disease

4

Cells w/ increased osteoid production (3)

Osteosarcoma, osteoid osteoma, osteoblastoma

5

Primitive round cells

Ewing sarcoma

6

Non-neoplastic osteoclasts and their precursors

Where?

Radiography?

Osteoclastoma (giant cell tumor)

Epiphyseal ends of long bones

Soap bubbles

7

69 female, hip and back pain. Skull deformity and B/L hearing loss over last 17 years. Elevated ALP, normal Ca++ and phosphate.

Primary abnormality? In what way?

What is the 2nd phase?

What is the 3rd phase?

Risks?

Paget's disease

Osteoclast dysfunction -- OVERACTIVE

Osteoblasts start trying to make up for osteoclast overactivity

Sclerotic phase

Osteosarcoma, hearing loss, high-output heart failure, tibia bowing

8

Osteoblast dysfunction

Osteoporosis

9

Defective mineralization of osteoid

Osteomalacia (Rickets)

10

Infarction of bone and marrow

Osteonecrosis

11

14 boy, 1 month history of knee pain, weight loss, pale. Densely sclerotic lesion in distal femur extending from growth late into diaphysis. Periosteum is lifted, forming angle w/ cortex.

Radiography?

Produces what? Others that do this?

How to know it's malignant?

Osteosarcoma

Codman's triangle
Sunburst appearance

Osteoid (Osteoid osteoma, osteosarcoma, osteoblastoma)

Weight loss, pallor

12

20 male, painless hard subQ mass in popliteal fossa. Has been there for years, did not change in size.

Arises in what?

Arise where?

2 possible presentations?

Complication? Signs of this? (3)

Osteochondroma

Bones of ENDOCHONDRAL origin

Metaphysis of long tubular bones

Pain on nerve impingement, or fracture

Chondrosarcoma transformation
- Continued growth after skeletal maturity, aggressive behavior, cortical irregularity

13

Punched-out lesions

Multiple myeloma

14

37, painful wrists over 3 months. Early morning stiffness. MCP joints of both hands swollen and tender. No nodules or vasculitic disease.

Associated findings? (3)

Radiography? (5)

Rheumatoid arthritis

Pannus formation and inflammatory erosion w/ swelling (MCP and IP joints), rheumatoid nodules

Radial deviation of wrist, ulnar deviation of fingers, swan-neck deformity, boutonniere deformity, Hitchhiker's thumb

15

Pain in weight bearing joints after use, knee cartilage loss starting medially. No inflammation, no systemic symptoms.

Associated symptoms? (6)

Osteoarthritis

Heberden nodes (DIP joints), Bouchard nodes (PIP joints), subchondral cysts, osteophytes, eburnation, synovitis

16

15-year-old male presented with increasing pain in
the left upper arm of approximately 3 months'
duration and a recent onset of low-grade fever. On
physical examination, there was some local tenderness
and soft tissue swelling over the proximal and mid
thirds of the left humerus.

Ewing sarcoma

17

Damage to p53 gene

Osteosarcoma

18

Injury causing decreased blood supply

Osteonecrosis

19

t(11;22)

Ewing sarcoma

20

Failure of normal bone resorption due to defective osteoclasts

Osteopetrosis

21

Best way to test for soft tissue involvement of Ewing sarcoma?

MRI

22

Sandwich vertebrae

Osteopetrosis

23

A 41-year-old presented to the chiropractor’s office with ongoing right sided back, hip and knee pain for the past 6 months. This began when the patient jumped off a two meter high roof and landed on his feet. He was recently treated with four months of oral corticosteroid
therapy. X-ray and MRI of the right femur shows a disruptive mass in the head of the femur.

Which artery is most likely insufficiency?

Osteonecrosis

Medial circumflex femoral a.

24

How does corticosteroid therapy cause osteonecrosis?

Interferes with ability to break down lipids, thus build up and clog arteries

25

Double line sign on T2WI

Osteonecrosis

26

Rim sign

Osteonecrosis

27

A 35 year old school teacher was admitted to the hospital with a complaint of swelling over her left wrist. The swelling had increased gradually over the preceding year. She did not sustain any kind of trauma or suffer from any fever in the last few months. Examination revealed a diffuse fusiform swelling over the wrist and distal forearm. The overlying skin was tense. However, no signs of inflammation were visible. Movement at all joints were full in range and were painless.

Imaging looks like?

Tumor cells?

Giant cell tumor (osteoclastoma)


Soap bubbles


NON-neoplastic osteoclasts and their precursors (REACTIVE)

28

Localized but highly destructive resorption of bone matrix by reactive osteoclasts

Giant cell tumor (osteoclastoma)

29

Bulging soft tissue mass delineated by thin shell of reactive bone

Giant cell tumor (osteoclastoma)

30

Giant cell tumor - most common locations

Distal femur, proximal tibia

31

Donut sign on bone scan

Giant cell tumor

32

Decreased bone mass, all normal lab values

Osteoporosis

33

Dense, brittle bones. Normal to low calcium.

Osteopetrosis

34

Decreased calcium and phosphate. Increased ALP and PTH.

Osteomalacia/rickets

35

Increased Ca and phosphate. Decreased PTH.

Hyper-vitamin D

36

Mandible -- triangular opacity of calcification

Osteopetrosis

37

Hair on end appearance

Osteopetrosis - increased hematopoietic activity

38

Young male, sacroiliac pain, stiff spine, uveitis, aortic regurgitation, poor chest expansion, exaggerated dorsal kyphosis

Radiography?

Ankylosing spondylitis

Bamboo spine (fusion)