Radiography - Vicki

Question 1

MR LEMONS

Answer 1

SMALL BLUE CELL TUMORS…

Melanoma
Rhabdomyosarcoma
Lymphoma
Ewings
Medulloblastoma
Other
Neuroblastoma
Small cell

Question 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?

Answer 2

Osteopetrosis

Spongiosa filling the medullary canal with no trabeculae

Erlenmeyer flask of tubular bones,

Pancytopenia

Question 3

Causes of osteonecrosis (avascular necrosis) - KNOW

Answer 3

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

Question 4

Cells w/ increased osteoid production (3)

Answer 4

Osteosarcoma, osteoid osteoma, osteoblastoma

Question 5

Primitive round cells

Answer 5

Ewing sarcoma

Question 6

Non-neoplastic osteoclasts and their precursors

Where?

Radiography?

Answer 6

Osteoclastoma (giant cell tumor)

Epiphyseal ends of long bones

Soap bubbles

Question 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?

Answer 7

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

Question 8

Osteoblast dysfunction

Answer 8

Osteoporosis

Question 9

Defective mineralization of osteoid

Answer 9

Osteomalacia (Rickets)

Question 10

Infarction of bone and marrow

Answer 10

Osteonecrosis

Question 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?

Answer 11

Osteosarcoma

Codman’s triangle
Sunburst appearance

Osteoid (Osteoid osteoma, osteosarcoma, osteoblastoma)

Weight loss, pallor

Question 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)

Answer 12

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

Question 13

Punched-out lesions

Answer 13

Multiple myeloma

Question 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)

Answer 14

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

Question 15

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

Associated symptoms? (6)

Answer 15

Osteoarthritis

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

Question 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.

Answer 16

Ewing sarcoma

Question 17

Damage to p53 gene

Answer 17

Osteosarcoma

Question 18

Injury causing decreased blood supply

Answer 18

Osteonecrosis

Question 19

t(11;22)

Answer 19

Ewing sarcoma

Question 20

Failure of normal bone resorption due to defective osteoclasts

Answer 20

Osteopetrosis

Question 21

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

Answer 21

MRI

Question 22

Sandwich vertebrae

Answer 22

Osteopetrosis

Question 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?

Answer 23

Osteonecrosis

Medial circumflex femoral a.

Question 24

How does corticosteroid therapy cause osteonecrosis?

Answer 24

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

Question 25

Double line sign on T2WI

Answer 25

Osteonecrosis

Question 26

Rim sign

Answer 26

Osteonecrosis

Question 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?

Answer 27

Giant cell tumor (osteoclastoma) Soap bubbles NON-neoplastic osteoclasts and their precursors (REACTIVE)

Question 28

Localized but highly destructive resorption of bone matrix by reactive osteoclasts

Answer 28

Giant cell tumor (osteoclastoma)

Question 29

Bulging soft tissue mass delineated by thin shell of reactive bone

Answer 29

Giant cell tumor (osteoclastoma)

Question 30

Giant cell tumor - most common locations

Answer 30

Distal femur, proximal tibia

Question 31

Donut sign on bone scan

Answer 31

Giant cell tumor

Question 32

Decreased bone mass, all normal lab values

Answer 32

Osteoporosis

Question 33

Dense, brittle bones. Normal to low calcium.

Answer 33

Osteopetrosis

Question 34

Decreased calcium and phosphate. Increased ALP and PTH.

Answer 34

Osteomalacia/rickets

Question 35

Increased Ca and phosphate. Decreased PTH.

Answer 35

Hyper-vitamin D

Question 36

Mandible -- triangular opacity of calcification

Answer 36

Osteopetrosis

Question 37

Hair on end appearance

Answer 37

Osteopetrosis - increased hematopoietic activity

Question 38

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

Answer 38

Ankylosing spondylitis Bamboo spine (fusion)