Radiology of Inflammatory Disorders Flashcards
(64 cards)
1
Q
aka for Osteitis Condensans Ilii
A
Osteitis Triangularis Ilii
2
Q
AS involves 2 extremities
A
- MC = hip
- 2nd = GH joint
3
Q
Which side of the SI joint does AS affect with the majority of changes?
A
Iliac side
4
Q
RA knee
A
- frequent involvement
- bilateral often
- swelling prominent
5
Q
RA Target site of Hip - an obvious finding could be
A
Acetabulae protrusio
6
Q
AS posture changes
A
- Lumbar - hypolordosis
- Thoracic - hyperkyphosis
- Cervical - hypolordosis
- Anterior weight bearing
Everything that keeps you bent forward
7
Q
RA (also Psoriatic) - advanced joint destruction, dislocation, flexion deformity & fibular deviation. This is called ______
A
Lanois deformity
8
Q
Psoriatic of SI joint is most commonly:
a) bilateral or unilateral?
b) symmetric or asymetric?
A
a) Bilateral
b) Asymetric
Note: According to Medscape, SI involvement may also entail SI widening and sclerosis
9
Q
AS radiographic “signs”
A
- Shiny Corner sign
- Ghost joint
- Star sign
- Bamboo spine
- Trolley track sign
- Railroad track sign
- Dagger sign
10
Q
AKA for Ankylosing Spondylitis (AS)
A
Marie-Strumpell disease
11
Q
Triad of Reiters
A
- Urethritis
- Conjunctivitis
- polyarthritis (lower extremity predominance) - plantar fascia or Achilles attachment
“Can’t see, can’t pee, can’t dance with me.”
12
Q
Labs associated with Reiter’s
A
- HLA B27 +
- high ESR
13
Q
AS initial site of involvement
A
SI joint
14
Q
Which gender is more affected by AS?
A
Males (10/1)
15
Q
AS radiographic hallmarks
A
- O = Osteopenia
- M = Marginal Syndesmophytes
- A = Ankylosis
- R = Romanus Lesions
- S = Shiny Corner Sign
- B = Barrel vertebra
- A = Anterior Squaring of Vertebra
- R = Rosary Bead sign
- P = pseudo widening (iliac side of SI)
O MARS BARP (think of Mars Bar - candy bar)
16
Q
Seronegative Spondyloarthropathies
A
- Psoriatic
- Enteric
- AS
- Reiters
17
Q
Labs of Psoriatic Arthritis
A
- high ESR
- HLA B27 (75% + with spine only, 35% with peripheral arthritis)
18
Q
Psoriatic Arthritis of the Spine - radiographic feature:
A
- Asymmetric, non marginal syndesmophytes - Unilateral
19
Q
Labs - AS
A
- high ESR
- HLA B27+
20
Q
Predominant area of infection associated with Psoriatc Arthritis
A
- hands and feet @ DIPS = primary
- spine and pelvis = secondary
21
Q
Complications of Enteric Spondyloarthropathy
A
- Chron’s
- UC
22
Q
Psoriatic radiographic features
A
- Asymetric
- Feet = usually DIPS
- Mouse Ears = adj to marginal erosions. Fluffy periosteal new bone formation.
- Pencil in Cup = whittling of the articular ends of phalanges at the PIP or DIP articulation that fit together.
- Pestle and mortar
- Mushroom & stem
- balancing Pagoda
- Cup & Saucer
5, 6, 7, 8 = same as 4.
23
Q
RA labs
A
- Rheumatoid Factor +
- high ESR
- high CRP (acute)
24
Q
Radiologic Hallmarks of RA
A
GettinN RA is a “BUMO”
- B = bilateral (in extremities)
- U = uniform joint space narrowing
- M = marginal erosions due to pannus formations
- O = osteoporosis
- N = nodules (pathologic diagnosis)
25
Radiographic Features of OCI are:
1. Bilateral
2. Symmetric
3. Trianglular shaped areas of sclerosis involving the Ilium at SI
4. Jt spacing & margins = normal
Note: I can remember a lab xray with this feature.
26
A common skin disorder associated with an erosive arthropathy
Psoriasis
Note: According to Medscape, patients rarely have Psoriatic Arthritis (PA) before any skin lesions appear.
27
Name of the healed lesion in AS disc
Andersson Lesion
28
RA spine
* C-spine only
* possible Atlas instability
29
MC causes of Osteitis Pubis
1. Over use in sports
2. post surgical - prostate, bladder
Bony resorption & spontaneous reossification @ pubic symphasis = OP
Note: Scuderi: OP is very, very rare.
30
Psoriatic (also RA) - fibular deviation with severe joint destruction. This is called \_\_\_\_\_.
Lanois deformity
31
Osteitis Pubis location
Pubic Symphasis
32
Target sites of Reiter's - bones
Foot & Ankle
* MTP joints
* IP joints
* +/- Achilles attachment
* +/- Plantar fascia insertion
* +/- erosions, osteoporosis, & fluffy periostitis and Achilles or Plantar Fascia insertion.
33
aka for Reither's Syndrome
Reactive Arthritis
34
SI Joint - RA
* not common involvement here
* Unilateral involvement
35
A spondyloarthropathy that is radiographically indistinguishable from AS due to its inflammatory bowel diseases
Enteric Spondyloarthropathy
36
SI joints, pattern - Reiters
Unilateral, asymetric
37
7 Main Inflammatory Disorders
1. Psoriatic
2. Enteric
3. AS
4. Reiters
5. RA
6. OCI (Osteitis Condensans Ilii)
7. OP (Osteitis Pubis)
38
RA target sites - MC joints affected in foot
MTP joints 4 & 5
IP joint #1
39
Typical patient with OCI is \_\_\_\_
Multiparous female
Age 20-40
Chronic LBP
40
Spine involvement - Reiters
syndesmophytes:
non-marginal
thick
Asymetric
Unilateral
Or not involved at all.
41
Name the disease
Osteitis Condensans Ilii
| (aka = Osteitis Triangularis Ilii)
42
Name the disease at red arrows
Osteitis Triangularis Ilii
| (aka = osteitis condensans Ilii)
43
Name the disease
Osteitis Condensans Ilii
44
Name the disease of this child
JRA
* periarticular osteopenia
* diffuse joint space narrowing
* epiphyseal deformities and overgrowth
* osteopenia and fusion of the carpals
45
True or False
JRA is always seronegative
False
15% are seropositive = more females
85% are seronegative = both sexes are equal
46
When JRA is systemic it is called _______ disease
Still's disease
47
Name the disease - patient age is over 40 years
RA
48
Name the disease. Patient age \> 40 years
RA
(O=anterior edge of Odontoid
A=posterior margin of anterior arch)
if \> 3 mm is unstable
49
Name the disease. Patient age \> 40 years. Seropositive
RA of foot
50
Name the disease
RA
51
Name the disease
RA
Bilateral involvement (greater at L than R)
Uniform Narrowing of hip joints
No Spurs (characteristic of RA)
52
Name the disease
RA
ulnar styloid erosion
53
Name the disease on R knee
RA
uniform joint space loss
erosion of tibial plateau
54
AKA for ankylosing spondylitis
Marie Stumpel's disease
55
Name the Disease
AS
56
Name the disease
AS
57
Name the disease
AS
58
AS - Radiographic features of SI
P.E.A.
Pseudowidening
Erosive & sclerotic
Ankylosis (stiffened joint)
59
Name the sign at the arrows & disease associated
Shiny Corner Sign - Ankylosing Spondylitis
60
Black arrows are pointing at _____ associated with \_\_\_.
Syndesmophytes, AS
61
Name the signs in A & B, and disease associated.
A) Trolley Track sign
B) saber sheath / dagger sign
disease = AS
62
A ragged vertebral body endplate may indicate _____ mobility of the adjacent body and is termed a _____ lesion in ankylosing spondylitis.
Ragged appearance of entire endplate is due to HYPER mobility - a fracture through a previously ankylosed joint.
Termed an ANDERSSON LESION
63
A fracture line through an ankylosed IVD is termed _____ in Ankylosing Spondylitis
a Carrot Stick fracture
64
