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Skeletal Radiology I > Unit 2 SG > Flashcards

Unit 2 SG Flashcards

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1
Q

If tumor has bone density w/ soft tissue mass it is:

A

Primary osseous malignancy

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2
Q

Chondrosarcoma

A

3rd MC primary osseous malignancy

Complications: slow growing w/ late metastasis to lungs

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3
Q

Chondrosarcoma: Types

A

Primary: MC overall is central/medullary; Peripheral - osseous stalk projecting from bone

Secondary: due to malignant degeneration of enchondroma or osteochondroma

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4
Q

Chondrosarcoma: Signs and Symptoms

A

Males, 40-60 yoa

Often discovered incidentally due to pelvic soft tissue mass that interferes with bowel or bladder function

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5
Q

Chondrosarcoma: Location

A

MC primary malignant bone tumor of hand, sternum and scapula

MC overall proximal feumer; pelvis; proximal humerus

Metaphyseal (origin)

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6
Q

Chondrosarcoma: Radiographic

A

Stippled, endosteal scalloping (common w/ cartilaginous and fibrous tumors), rings (birthday present), mixed (more lytic w/ matrix calcification).
If more cloud-like = osteosarcoma
If stalk = osteochondroma

Expansile osteoLytic lesion

May have cortical destruction

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7
Q

Chondrosarcoma: DDx

A

Early may look like Enchondroma

If Ca is lacking, looks like Giant Cell

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8
Q

Benign Cartilage Forming Tumors

A

Whenever you see a CENTRAL cartilaginous lesion in a long bone, think:
Chondrosarcoma
Enchondroma
Medullary bone infarct

Any benign cartilaginous tumor can undergo malignant degeneration after being irradiated!

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9
Q

Osteochondroma

A

AKA: osteocartilaginous exostosis; coat-hanger exostosis

Cartilaginous capped bony stalk

MC benign skeletal growth

MC 10-20 yoa

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10
Q

Osteochondroma: Three Presentations

A

Solitary

Multiple

HME (Hereditary Multiple Exostosis)

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11
Q

Osteochondroma: Two Types

A

Pedunculated - stalk

Sessile - broad based (osseous base) w/ localized widening of shaft

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12
Q

Osteochondroma: Locations

A

Pedunculated - MC distal femure (metaphysis), proximal tibia

Sesile - MC humerus

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13
Q

Osteochondroma: Signs and Symptoms

A

Asymptomatic

MC complaint is hard PAINLESS mass near a joint

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14
Q

Osteochondroma: Complications

A

Fx of stalk = pn

Pressure on surrounding nerves/vessels

Malignant degeneration —> Chondrosarcoma

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15
Q

Osteochondroma: Radiographic

A

Uninterrupted merging of cortex of host bone w/ osteochondroma

Cartilaginous cap can’t be see w/o Ca

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16
Q

Osteochondroma: DDx

A

Supracondylar Process points TOWARDS the joint
MC elbow
Osteochondroma (aka coat hanger exostosis) point AWAY from joint

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17
Q

Hereditary Multiple Exostosis (HME)

A

AKA diaphyseal aclasia

Relatively common condition, malignant degeneration —> chondrosarcoma (25% of the time)

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18
Q

Hereditary Multiple Exostosis (HME): Location

A

MC metaphysis of lower extremity long bones and pelvis

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19
Q

Hereditary Multiple Exostosis (HME): Signs and Symptoms

A

MC 2-10 yoa

Usually bilateral and symmetrical

Bayonet Hand Deformity = HME

  • shortening of ulna
  • outward bowing of radius
  • subluxation of radio-ulnar joint
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20
Q

Enchondroma

A

AKA: Chondroma

MC benign tumor of hand; if you see an osteolytic lesion w/ matrix calcification in hand = ENCHONDROMA

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21
Q

Enchondroma: Signs and Symptoms

A

Equal distribution b/w Male and Female

Multiple Enchondromas = Ollier’s Dz

  • Marked shortening of extremities
  • Maffucci Syndrome = Ollier’s Dz + Cavernous Hemangiomatosis (looks like lots of phleboliths in hands)
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22
Q

Enchondroma: Radiographic

A

Expansile

Endosteal Scalloping - always suggests cartilaginous tumor type

No cortical breakthrough - NOT aggressive

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23
Q

Chondroblastoma

A

AKA: Codman’s Tumor.

Thin sharply demarcated sclerotic margin characteristic

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24
Q

Chondroblastoma: Signs and Symptoms

A

10-25 yoa

Joint PAIN, tenderness, heat and swelling

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25
Chondroblastoma: Locations
Eccentric Epiphyseal cartilage plate, extends into epiphysis; ONLY tumor that originates here. Distal femur, proximal tibia, TUBEROSITIES or TROCHANTERS b/c they have a growth plate.
26
Chondroblastoma: DDx
Giant Cell; biggest difference is that the MAJORITY of these will be in metaphysis
27
Chondromyxoidfibroma
RARE (< 1%) benign primary neoplasm composed of chondroid, fibrous and myxoid tissues. Male = Female, 10-30 yoa
28
Chondromyxoidfibroma: Location
MC proximal tibia Metaphyseal Eccentric oval/round
29
Chondromyxoidfibroma: Appearance
Radiolucent Scalloped (cartilaginous) - thin on cortical side Pseudo-trabeculations (soap bubble)
30
Fibrosarcoma
Primary malignant bone tumor that does NOT form neoplastic osteoid or cartilage
31
Fibrosarcoma: Two Types
Eccentric (medullary) Periosteal
32
Fibrosarcoma: Malignant Degeneration (Secondary Cancer)
Fibrous Dysplasia -MC Fibrosarcoma Paget Dz - MC Osteosarcoma - 2nd MC Fibrosarcoma
33
Fibrosarcoma: Signs and Symptoms
30-50 yoa Local pain and swelling Hematogenous metastasis to LUNGS
34
Fibrosarcoma: Location
50% in KNEE Long bones MC in young Flat bones MC in old Metaphysis that extends into epiphysis
35
Fibrosarcoma: Radiographic
SEQUESTRATION Cortical disruption + LARGE soft tissue mass common
36
Fibrosarcoma: DDx
Giant cell - both begin in metaphysis and extend into epiphysis
37
Chordoma
UNCOMMON primary malignant tumor arising from notochord remnants; MIDLINE tumor
38
Chordoma: Signs and Symptoms
30-70 yoa Constipation, urinary dysfunction, perineal pain/numbness MAY CROSS JOINTS Should look like a centrally destroyed sacrum/coccyx w/ calcification
39
Chordoma: Location
MC Sacrococcygeal
40
Chordoma: DDx
Osteomyelitis - b/c crosses joints Giant Cell - b/c it’s the MC primary tumor of sacrum
41
Giant Cell
QUASIMALIGNANT (begins benign but often undergoes malignant degeneration) AKA: Osteoclastoma, GCT
42
Giant Cell: Signs and Symptoms
Female > Male 20-40yoa (only this and ABC)
43
Giant Cell: Locations
MC distal femur (KNEE) MC benign tumor of SACRUM - even though out of the 4 MC painful benign tumors, it’s the LEAST likely to involve the spine
44
Giant Cell: Radiographic
Metaphysis and WILL extend to epiphysis Eccentric and more CIRCULAR in appearance CLASSIC appearance - well defined margin, thin cortex, EXPANSILE, radiolucent, extends to EPIPHYSIS (subarticular surface). ***Birthday = knee, eccentric, 35yoa female w/ knee pn About 50/50 purely LYTIC vs SOAP BUBBLE No sclerosis
45
Giant Cell: DDx
ABC - MC in knee; the easiest way to distinguish is pt age (GCT = 20-40; ABC = 5-20)
46
Aneurysmal Bone Cyst
AKA: ABC Highly EXPANSILE appearance
47
Aneurysmal Bone Cyst: Signs and Symptoms
5-20 yoa FEMALES > Males (only this and GCT)
48
Aneurysmal Bone Cyst: Location
MC Femur, Tibia, T-Spine, L-Spine MC benign tumor of CLAVICLE
49
Aneurysmal Bone Cysts: Radiographic
Metaphyseal (can cross to epiphysis) Eccentric and more OVAL in appearance (down long axis of bone) KNOWN to cross an OPEN physis EXPANSILE (very thin cortex, may not appear on plain film) 50/50 radiolucent or trabeculation (soap bubble) BUTTRESS at EDGE of lesion is common Fluid-fluid levels on MRI
50
Hemangioma
MC benign tumor of spine. Arises from newly formed blood vessels MC type is CAVERNOUS vs capillary
51
Hemangioma: Location
Lower T-Spine, Upper L-Spine Frontal bone when in skull
52
Hemangioma: Radiographic
CLASSIC appearance “Jailhouse Sign”, courduroy, vertical striations Solitary Sunburst or spoke-wheel in skull; will extend up out of cortex
53
Hemangioma: DDx
Osteoporosis - b/c body eats horizontal trabecular bone first, leaving the vertical striations. Will be MULTIPLE levels Paget Dz - lays down new bone in vertical striations. Will have cortical thickening and bone enlargement
54
Simple Bone Cyst
AKA: SBC, unicameral bone cyst, solitary bone cyst, juvenile bone cyst NON-PAINFUL, FLUID-filled cyst; NO chance of malignant degeneration
55
Simple Bone Cyst: Two Types
Active - adjacent to growth plate Latent - displaced from growth plate
56
Simple Bone Cyst: Signs and Symptoms
3-14 yoa Pain following trauma = lesion proximal humerus = SBC
57
Simple Bone Cyst: Locations
Metaphysis of proximal humerus/femur
58
Simple Bone Cyst: Radiographic
CLASSIC appearance - centrally located, truncated “ice cream cone” appearance (broad region at the metaphysis, rarely exceeds diameter of growth plate) Fallen Fragment Sign - can be seen w/ fx, piece of bone falls into the fluid compartment and moves around with different x-ray positions
59
Simple Bone Cyst: DDx
ABC - eccentric and PAINFUL Giant Cell - eccentric and PAINFUL Fibrous Dysplasia - MC neck of femur BUT older people. More stable b/c lesion is solid (not liquid). Rind Sign - looks like buttressing (sclerosing of inferior cortex) Chondroblastoma - MC originate in EPIPHYSIS and PAINFUL Enchondroma - Fingers Chondromyxoid Fibroma
60
Intraosseous Lipoma
RAREST primary benign bone tumor; ~200 cases EVER recorded Lytic lesion MC Tibia and Fibula Narrow ZOT Sclerotic border
61
Synovial Sarcoma
ONLY PRIMARY MALIGNANT tumor in DIRECT contact w/ joint surface 30-50 yoa MC pain and soft tissue mass at site of tumor MC lower limbs SOLITARY
62
Paget Dz
AKA: Osteitis Deformans Benign; Bone softening dz (even though it’s prolific, it’s soft bone). Precise etiology unknown; More common in Northern US, England, and Australia 50 yoa
63
Paget Dz: Signs and Symptoms
Bone Pain - insidious Neural compression, neuropathy (foramen closure) Histolytic HALLMARK - Mosaic pattern FOUR stages - determins whether it’s LYTIC or BLASTIC at the time
64
Paget Dz: Signs and Symptoms - Stage 1
AKA osteolytic, destructive, hot, monophasic MC skull Lab - Increased urinary hydroxyproline d/t breakdown of collagen BLADE OF GRASS OSTEOPOROSIS CIRCUMSCRIPTA
65
Paget Dz: Signs and Symptoms - Stage 2
AKA intermediate, mixed, reparative, combined, biphasic MC Pelvis; also MC site overall MC seen radiographically Lab - increased alkaline phosphatase (10-20x normal) d/t excessive bone deposistion COTTON-WOOL skull
66
Paget Dz: Signs and Symptoms - Stage 3
AKA sclerotic, ivory, cool, inactive, quiescent MC Pelvis, vertebra (ivory) Lab - Increased alkaline phosphatase but much closer to normal d/t decreased bone destruction w/ continued deposition of abnormal bone
67
Paget Dz: Signs and Symptoms - Stage 4
AKA malignant degeneration MC Femur OSTEOSARCOMA is the MC secondary tumor, followed by FIBROSARCOMA 60-80 yoa If original site becomes PAINFUL = malignant degeneration. Scintigraphy should be used to DOCUMENT all original sites
68
Paget Dz: Distribution
``` MC to LC: Pelvis/Sacrum Femur Skull Tibia Vertebra Clavicle Humerus Fibula - LC overall ```
69
Paget Dz: Radiographic
HALLMARKS - must say what side lesion is on (L or R) ~Cortical Thickening ~Coarsened Trabeculae - thickness increased in weight bearing lines (can resemble corduroy, hemangioma) ~Bone Enlargement ~Increased/Decreased bone density, depending on stage Long lesion in long bones Ward’s Triangle - in neck of femur; if OBVIOUS triangle = Paget Ivory Vertebra Picture Frame VB
70
Paget Dz: Complications
Shepherd’s Crook - Coxa vera deformity of hip joint
71
Fibrous Dysplasia
Benign; common disorder, bone undergoes physiologic resorption and replaced with woven bone in collagenous matrix. AKA: Fibro-osseous dysplasia 2nd or 3rd Decade
72
Fibrous Dysplasia: Three Forms
Monostotic Polyostotic Polyostotic w/ Endocrine Dysfunction
73
Fibrous Dysplasia: Three Forms - Monostotic
MC, asymptomatic MC location overall, INTERTROCHANTERIC region of proximal femur, 2nd rib
74
Fibrous Dysplasia: Three Forms - Polyostotic
Pseudo-fractures and deformities Larger lesions Involvement of skull and facial bones tends to produce more sclerosis If pelvis involved, femur usually is as well Psuedoarthrosis -MC lower extremity -Neurofibromatosis and fibrous dysplasia m/c causes
75
Fibrous Dysplasia: Three Forms - Polyostotic w/ Endocrine Dysfunction
McCune Albright Syndrome (almost exclusively precocious young females) Triad ~Cafe-au-lait spots: Coast of Maine (jagged) = Fibrous Dysplasia, MC extraskeletal manifestation of FD. Coast of California (smooth) = Neurofibromatosis, MC extraskeletal manifestation in FIBROMA MULLOSCUM ~Polyostotic Fibrous Dysplasia ~Endocrine Dysfunction
76
Fibrous Dysplasia: Location
Does NOT extend into epiphysis Metaphyseal Diaphyseal MC benign rib lesion - common cause of EXPANSILE rib lesion; common extra-pleural sign, MC caused by Osteolytic Metastasis
77
Fibrous Dysplasia: Signs and Symptoms
Malignant degeneration (opposite of Paget Dz) - MC FIBROSARCOMA - 2nd MC OSTEOSARCOMA
78
Fibrous Dysplasia: Radiographic
GROUND GLASS Rind Sign - thick sclerotic border around the lesion Cortical THINNING - maybe intramedullary scalloping Long lesion in long bone PSEUDOARTHROSIS - MC caused by Fibrous Dysplasia and Neurofibromatosis Leontiasis Ossea - “lion-like” skull
79
Fibrous Dysplasia: Complications
Shepherd’s Crook - coxa vera deformit of hip joint Cherubism - rounded face; “Eyes raised to heaven”
80
Neurofibromatosis
Autosomal dominant genetic disorder that affects cell growth of neural tissue Malignant degeneration to NEUROFIBROSARCOMA MC of a group known as PHAKOMATOSES
81
Neurofibromatosis: Two Forms
NF-1: aka Von Recklinghausen’s Dz NF-2: aka Central Neurofibromatosis
82
Neurofibromatosis: Two Forms - NF-1
AKA: Von Recklinghausen’s Dz MC form, affects primarily peripheral nerves Triad 1. Cafe-au-lait spots (Coast of CA; 6+ spots considered dx) 2. Fibroma Molluscum (soft elevated cutaneous tumors) 3. Various osseous alterations (scoliosis etc)
83
Neurofibromatosis: Two Forms - NF-2
AKA: Central Neurofibromatosis Dx by the presence of bilateral acoustic schwannomas
84
Neurofibromatosis: Radiographic
MC KYPHOSCOLIOSIS/SCOLIOSIS Asterion Defect - virtually diagnostic Macrocranium Posterior Vertebral Scalloping - d/t dural ectasia (dilation) Dumbell Neurofibroma - can erode unilateral pedicle Multiple Non-Ossifying Fibromas

Skeletal Radiology I (4 decks)

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