Dx Imaging

• MC BBT of the appendicular skeleton
• either pedunculated or sessile
• hereditary multiple exostosis (HME) are multiple osteochondromas
• 20% undergo malignancy

• benign
• diaphyseal/metaphyseal location
• centrally located
• less than 20 yo
• fluid filled
• associated with fallen fragment sign

• diaphyseal/ metaphaseal location, eccentrically loacted
• less than 20 yo

• epiphyseal/metaphyseal location
• 20-40 yo
• 20% of time quasi malignant
• assocated with soap bubble lesion
• benign

• epiphyseal/metaphyseal location
• less than 20 yo

• night pain relieved by aspirin
• radiolucent central nidus with severe reactive sclerosis and bone expasion
• benign

night pain relieved by aspirin appears like an osteoid osteoma

• MC BBT of hand
• stippled appearance
• multiple enchondromas is ollier's disease
• ollier's - 10-50% rate of malignant degeneration
• Soft tissue calcification is known as maffucci's syndrome

• MC BBT of spine
• vertical striations
• corduroy cloth appearance

• bone island
• round or oblong radiopaque lesion

multiple bone island

MC BBT to affect the neural arch

• MC BBT affects the skull
• found in frontal sinus most commonly and best seen on the calwell projection

• monostotic form associated with rind sign
• polystotic form
• physiologic resorption of normal bone replaced by fibrous tissue
• causes deformity
• saber shin tibia and sheppards crook
• ground glass appearance
• cafe au lait spots
• coast of maine appearance

• familial history
• pt may present with scoliosis
• cervical kyphosis
• vertebral body scalloping with IVF enlargement
• cafe au lait spots with Coast of California appearance

• >50 yo cachexia, weightloss, anemia, MC primary malignancy of bone, malignant proliferation of plasma cells infiltrating bone marrow
• multiple dark densities that are similar in size (punched out lesions) can cause pathological collapse
• rain drop skull
• labs: M spike on the immunoelectrophoresis 2. reversal of the albumin globulin ration 1:1, 3. bence jones proteinuria, 4. elevated ESR,
• test- bone scan cold

• lytic and blastic
• MC malignant tumor of bone

• >40 yo recent unexplained weight loss, skeletal pain, worse at night
• trabeculae reabsorbed turns the bone darker in color
• moth eaten or permeative pattern of destruction
• eats away pedicle of bone
• swiss cheese appearance in the skull
• labs: alkaline phophatase
• special test: bone scan- hot

• MC metastasis in 20-40 yo males
• bone becomes more radiopaque in color: ivory white vertebrae with anterior body scalloping
• unilateral hilar lymphadenopathy in caucasians seen on the PA chest view
• need biopsy to confirm
• Reed Sternberg Cells

• >40 yo ivory white vertebrae
• MC cause is from prostatic carcinoma
• Labs: increased alkalkine phosphatase
• special test bone scan-hot

• males >50 yo
• stages: 1. lytic or destructive 2. combined 3. sclerotic 4. malignant
• causes cortical thickening bone expansion, picture frame vertebrae bowing deformities
• labs: increased alkaline phosphatase and urinary hydroxyproline
• tests: bone scan- hot

• MC malignancy found in children
• ages 10-30
• periosteal rxn that is spiculated, radiating, sunburst in appearance
• labs: increased alkaline phosphatase
• hot bone scan

>40 yo creates a spiculated radiating sunburst periosteal rxn of bone

10-25 yo MC found in diaphysis of long bones. Permeative lesion that causes a multiparalleled onion skin type of periosteal rxn. Bone expansion, codman's triangle, saucerization

• >40 yo aberrant notochordal cell tumor.
• MC found in Sacrum
• 2nd MC location is skull

• Females 13-19 names for the side of the major convexity
• Rotatory Scoliosis- sp deviated to concavity
• Simple Scoliosis- sp deviate to convexity
• Cobb's and risser ferguson's to measure
• measurments for 25 yo and younger:
• under 20- adjust and monitor
• 21-40 send to orthopedist for bracing
• over 40 is surgical
• over 50 is cardio pulmonary compromise
• monitor scoliosis1. risser's sign, wrist films, tanner stages

• Bilateral uniform loss of joint space, rat bite erosions, pannus formation, localized periarticular osteoporosis, symmetrical distribution, atlanto-axial instability
• Bouchards PIP, Haygarth MCP DIP is spared Swan neck and boutonneire deformity, ulnar deviation, baker's cyst
• MC cause of bilateral protrusio acetabuli
• Labs: RA latex, FANA, ESR, CRP, normocytic normochromic anemia
• dry eyes and mouth presented is called Sjogrens

• Males 15-35 yo starts in SI joints, LBP, morning stiffness, Forester's bowstring and Lewin's supine iritis
• Si joints bilateral fusion
• shiny corner sign, bilateral marginal syndesmophytes, squaring of body, bamboo spine, dagger sign, trolley track sign
• labs: HLAB27 adn ESR

• Identical to AS with GI Dysfxn
• chrons, diverticulitis, ibs

• males 20-50 yo silver scales and pitted nails cocktail sausage digits
• increased joint space, pencil in cup deformity, mouse ear deformity, ray sign, atlantoaxial instability, non marginal syndesmophytes
• HLAB27 positive

• males 20-30 plus or minus, cant see cant pee cant dance with me
• HLAB27 positive

• females, sunlight precipitates a skin rash (malar or butterfly rash) alopecia, raynaud's penomenon can cause ulnar deviation of the phalanges
• LE prep, FANA, RA latex ESR

• females 30-50 yo CREST syndrome erosions of the distal tufts
• labs: FANA, RA latex

• multiparous females
• 20-40 yo bialteral symmetric triangular sclerotic areas on the lower half of the ilium
• joint space is normal
• self resolving
• no labs
• trochanteric belt

• non inflammatory, MC in fingers and weight bearing joints, usually stiffens with rest adn improves with activity
• complications inclue spinal stenosis and ivf encraochment
• MC at C5/C6
• heberden's DIP and Bouchard's PIP
• asymmetrical non uniform loss of joint space

• males >40 yo associated with diabetes mellitus
• candle was drippings, 4 contguous segments infolved ALL

• Secondary to impaired sensory fx in joints. seen wtih diabetes, tabes dorsalis, syphilis and syringomyelia
• 6D's: distention, density of subchondral sclerosis, debris, dislocation, disorganization, destruction of bone

• MC join affected in the knee
• Results in multiple loose bodies within the joint that are round or ovoid in shape
• popcorn like look in the knee

• males >40 yo.
• overproductoin of uric acid
• foods high in purines
• MTP of the big toe (podagra)
• overhanging margin: juxta articular erosions
• Labs: increased uric acid, esr
• take: acute-colchicine, chronic allopurinol

• thin linear calcification parallel to the articular cortex within the joint space.
• called chondrocalcinosis when affecting carilage
• MC in the knee

• MC affects shoulder joint
• round or oval calcifications near the insertion of a bursa or tendon

• fever, chills, history of trauma, surgery and warm tender swollen joint
• WBC Count

AVN of carpal scaphoid

AVN of tibial tuberosity