musculoskeletal radiology 1 / musculoskeletal radiology 5 sternoclavicular sclerosis stop sapho...
TRANSCRIPT
From: Radiology: The Oral Boards PrimerBy: A. Mehta and D. P. Beall © Humana Press Inc., Totowa, NJ
1Musculoskeletal Radiology
Includes plain film diagnosis in all areas of the musculoskeletal systemplus any related special or imaging procedures, including CT, interven-tional techniques, and MRI.
1
GENERAL CASE CATEGORIES1. General including Metabolic2. Congenital3. Tumors4. Arthritis
Chapter 01_1_32_F 2/20/06 2:32 PM Page 1
General
BASILAR INVAGINATIONPF ROACH
Paget diseaseFibrous dysplasiaRicketsOsteogenesis imperfecta, OsteomalaciaAchondroplasiaCleidocranial dysplasiaHyperparathyroidism, Hurler syndrome
2 Radiology: The Oral Boards Primer
Chapter 01_1_32_F 2/20/06 2:32 PM Page 2
Chapter 1 / Musculoskeletal Radiology 3
SUBCHONDRAL CYSTSCOORS
CPPD Osteoarthritis Osteonecrosis Rheumatoid arthritisSynovial-based tumors
Chapter 01_1_32_F 2/20/06 2:32 PM Page 3
4 Radiology: The Oral Boards Primer
ACETABULAR PROTRUSIONPROTrusio
Paget diseaseRheumatoid arthritisOsteomalaciaTrauma
Chapter 01_1_32_F 2/20/06 2:32 PM Page 4
Chapter 1 / Musculoskeletal Radiology 5
STERNOCLAVICULAR SCLEROSISSTOP
SAPHO syndromeTraumatic osteolysisOsteomyelitis/OsteosarcomaPagets
DISTAL CLAVICLE EROSIONSHIRT
SclerodermaHyperparathyroidismInfectionRheumatoid arthritisTraumatic osteolysis
Chapter 01_1_32_F 2/20/06 2:32 PM Page 5
SCLEROSIS-GENERALIZEDR.S.M.O.P.M.M.P.F. (Regular sex mneumonic)
Renal osteodystrophySickle cell diseaseMyelofibrosisOsteopetrosisPyknodysostosisMastocytosisMetastasisPagetsFluorosis
OSTEONECROSISASEPTIC
AnemiasSickle cell disease/SLEETOH/Exogenous steroidsPancreatitisTraumaInfectionCaisson’s disease
6 Radiology: The Oral Boards Primer
Chapter 01_1_32_F 2/20/06 2:32 PM Page 6
Chapter 1 / Musculoskeletal Radiology 7
ACRO-OSTEOLYSISPINCH FO
PsoriasisInfectionNeuropathic Collagen vascular diseaseHyperparathyroidismFamilial (Hadju Cheney)Other—polyvinyl alcohol
Chapter 01_1_32_F 2/20/06 2:32 PM Page 7
8 Radiology: The Oral Boards Primer
CHONDRAL CALCIFICATIONHOGWASH
HyperparathyroidismOchronosisGoutWilson’s DiseaseArthritisPSeudogoutHemochromatosis
Chapter 01_1_32_F 2/20/06 2:32 PM Page 8
Chapter 1 / Musculoskeletal Radiology 9
Congenital
METAPHYSEAL BANDSDENSE
LINES
Lead poisoningInfantile growth arrestNormal, 3 yrLEukemia treatedSyphillis
LUCENT
NORMAL TENDER LOVING CARE
Normal (neonates)TORCHLeukemiaChronic illness
ERLYMEYER FLASKCHONGO
Craniometaphyseal dysplasiaHemoglobinopathiesOsteopetrosisNiemenn PickGaucher’s DiseaseOther
Chapter 01_1_32_F 2/20/06 2:32 PM Page 9
10 Radiology: The Oral Boards Primer
GRACILE BONESNIMROD
NeurofibromatosisImmobilizationMuscular dystrophyRheumatoid arthritisOsteogenesis imperfectaDysplasias
Chapter 01_1_32_F 2/20/06 2:32 PM Page 10
Chapter 1 / Musculoskeletal Radiology 11
MADELUNG DEFORMITYHITDOC
Hurler syndromeInfectionTraumaDyschondrosteosisOsteochondromaCongenital–Turner’s syndrome
SHORT METACARPALSBIC PEN
Basal Cell Nevus syndromeIdiopathicChromosomal–Turner’s syndromePseudohypoparathyroidism/PseudoPseduo-
hypoparathyroidism
Chapter 01_1_32_F 2/20/06 2:32 PM Page 11
12 Radiology: The Oral Boards Primer
Tumors
DIAPHYSEAL LESIONS IN GENERALCEMENT
CystsEnchondromaMetastasisEosinophillic granuloma (EG)Non-ossifying fibroma (NOF)TB/infections
CORTICAL LESIONMOFOS
MetastasisOsteomyelitisFibrosarcomOsteoid osteomaStress fracture
Chapter 01_1_32_F 2/20/06 2:32 PM Page 12
Chapter 1 / Musculoskeletal Radiology 13
ILIAC WING LESIONSFibrous dysplaisaUnicameral bone cystChondrosarcomaMets/Myeloma/PlasmacytomaEwings
VERTEBRA PLANAIMELT
InfectionMets/MyelomaEGLymphoma/LeukemiaTrauma
BONY SEQUESTRUMLIFE
LymphomaInfectionFibrosarcomaEG
RIB LESIONFAME
Fibrous dysplasiaABCMetastatic/Myeloma/LymphomaEG/Enchondroma
Chapter 01_1_32_F 2/20/06 2:32 PM Page 13
14 Radiology: The Oral Boards Primer
FOCAL SCLEROTIC LESIONHOME LIFE
Healed NOFOsteomaMetastasisEwing’s sarcomaLymphomaInfection/InfarctFibrous dysplasiaEnchondroma
PERMEATIVE LESIONSFIRE
Fibrosarcoma (Desmoid/MFH)InfectionRound cell tumors EGMets/Myeloma
EPIPHYSEAL LESIONSCIGS
ChondroblastomaInfectionGiant cell tumor/Granuloma (EG)Subchondral cyst
Chapter 01_1_32_F 2/20/06 2:32 PM Page 14
Chapter 1 / Musculoskeletal Radiology 15
SKULL LESIONMEL TORME
MetastasisEGLymphomaTBOsteomyelitisRadiationMetsEpidermoid
TIBIAL LESIONFOAM
Fibrous dysplasiaOsteofibrous dysplasiaAdamantinomaMetastasis
POSTERIOR VERTEBRAL BODY LESIONGO TAPE
Giant cell tumor OsteoblastomaTBABCPaget diseaseEG
Chapter 01_1_32_F 2/20/06 2:32 PM Page 15
16 Radiology: The Oral Boards Primer
CALCANEAL LESIONBIG G
Bone cyst-unicameralIntraosseous lipomaGanglion Giant cell tumor
FINGER TIP LESIONGEMS
Glomus tumorEpidermoid/EnchondromaMetastasis (lung almost exclusively)Sarcoid
SOFT TISSUE CALCIFICATION/OSSIFICATIONMy GHOSTS
Myositis ossificansGoutHyperparathyroidismOchronosisScleroderma/connective tissue diseaseTumoral calcinosisSarcoma (synovial cell)
Chapter 01_1_32_F 2/20/06 2:32 PM Page 16
Chapter 1 / Musculoskeletal Radiology 17
SACRAL LESIONCAN
Chondrosarcoma/ChordomaABC/GCTNeurofibromatosis
And always Mets/Myeloma/Lymphoma
FLUID-FLUID LEVELHOT MASS
HemangiOmaTelangiectatic osteosarcomaMetastasisABC/GCTSynovial cell Sarcoma
Chapter 01_1_32_F 2/20/06 2:32 PM Page 17
18 Radiology: The Oral Boards Primer
Arthritis
INFLAMMATORY ARTHRITIS1. RF+
Rheumatoid Arthritis –Symmetric
SLE–Subluxation/nonerosive
Scleroderma–DIP, PIP erosions–Soft tissue Ca2+
–Acroosteolysis
Dermatomyositis–Soft tissue Ca2+
Chapter 01_1_32_F 2/20/06 2:32 PM Page 18
Chapter 1 / Musculoskeletal Radiology 19
Reiters–Foot > Hand–Bony Proliferation
2. RF–
Ankylosing Spondylitis–SI joint involvement
Psoriasis–Erosive–Bony proliferation–Asymmetric–Sausage digit–Ivory phalanx–Pencil in cup
Inflammatory Bowel Disease (IBD)–Arthritis with IBD
Chapter 01_1_32_F 2/20/06 2:32 PM Page 19
3. EROSIVE OA
–Dip Joints
20 Radiology: The Oral Boards Primer
Chapter 01_1_32_F 2/20/06 2:32 PM Page 20
CRYSTAL ARTHRITIS1. DEPOSTION
Gout–Marginal erosions–Overhanging edges–Preserved joint space
Chapter 1 / Musculoskeletal Radiology 21
Chapter 01_1_32_F 2/20/06 2:32 PM Page 21
22 Radiology: The Oral Boards Primer
CPPD–ChondroCa2+
–Cysts–2nd and 3rd MCP–SLAC–TFCCa2+
Chapter 01_1_32_F 2/20/06 2:32 PM Page 22
Chapter 1 / Musculoskeletal Radiology 23
2. OTHER
Hemochromatosis
Acromegaly
OtherOchronosis
–Disc calcification
Multicentric reticular histiocytosis–Symmetric–No osteopenia
Infection–Crosses Joint Space
Chapter 01_1_32_F 2/20/06 2:32 PM Page 23
24 Radiology: The Oral Boards Primer
OH MY GOD LESIONSVERY BIZARRE LOOKING GENERALIZEDLESIONS THAT YOU HAVE NO IDEAWHAT IT IS, THINK OF:
Paget diseaseFibrous dysplasiaNeurofibromatosisCharcot joints
Chapter 01_1_32_F 2/20/06 2:32 PM Page 24
Chapter 1 / Musculoskeletal Radiology 25
Metabolic
OSTEOPENIAGENERALIZED
Senile osteoporosisOsteomalaciaEndocrine abnormalities
–Cushings (too much)–Hypogonadism (too little)
Anemia/Myelofibrosis/Gauchers –Bone marrow
Congenital–Osteogenesis imperfecta
Hyperparathyroidism
Chapter 01_1_32_F 2/20/06 2:32 PM Page 25
26 Radiology: The Oral Boards Primer
FOCAL
Reflex sympathetic dystrophy (complex regionalpain syndrome)
DisuseTransient osteoporosisMigratory osteoporosis
Chapter 01_1_32_F 2/20/06 2:32 PM Page 26
Chapter 1 / Musculoskeletal Radiology 27
SPINECALCIFICATION OF THE ANNULUS FIBROSIS
Ankylosing spondylitis–Disks unremarkable
Ochronosis–Disks calcified–Abn SI joints
OSTEOPHYTES
DISH–Disks unremarkable–Normal SI joints
Chapter 01_1_32_F 2/20/06 2:32 PM Page 27
28 Radiology: The Oral Boards Primer
SYNDESMOPHYTES
PsoriasisReiters
MARGINAL OSTEOPHYTES
Spondylosis or degenerative
OSTEOPHYTOSIS
Chapter 01_1_32_F 2/20/06 2:32 PM Page 28
Chapter 1 / Musculoskeletal Radiology 29
ARTHRITIS BASICS AND ARTHRITIS BY LOCATION
ABCDS
Wrist1st CMC, TFC—CPPDRadiocarpal joint—osteoarthritisCMC—gout (marginal erosions)
HandDIP + PIP
Osteoarthritis–Osteophytes–No erosions
Erosive osteoarthritis –Osteophytes–Erosions–Females
Psoriasis/Reiters–No osteophytes–Erosions
MCP + PIPRheumatoid
–Erosions–No osteophytes–Osteopenia
Psoriasis/Reiters–Erosion–Bony proliferation
MCPInflammatory
–ErosionsCPPD/hemochromatosis
–Osteophytes
FootMTP JOINTS
RAGoutOANeuropathic
MIDDLE/HINDFOOT
RAOsteoarthritis
Hip
BONY PROLIFERATION
OA–Superolateral migration
Ankylosing spondylitis–Axial migration–SI joint involvement symmetric
Psoriasis/Reiters–Axial migration–SI joint involvement asymmetric
CPPD–Chondrocalcinosis
NO . PROLIFERATION
RA–Acetabular protrusio–Osteopenia
AlignmentBoneCartilage/calcificationsDistributionSoft tissues
Chapter 01_1_32_F 2/20/06 2:32 PM Page 29
30 Radiology: The Oral Boards Primer
KneeCOMPLETE JOINT INVOLVEMENT
RA–No bony proliferation–Osteopenia–Cyst formation
JRA/hemophilia–Wide femoral notch–High density effusion
Psoriasis/Reiter’s–Asymmetric–Bony proliferation
MEDIAL INVOLVEMENT
Osteoarthritis
PATELLOFEMORAL INVOLVEMENT
CPPD
ShoulderGLENOHUMERAL JOINT
CPPD–vs osteoarthritis–not a weight-bear-
ing joint
ACROMIOCLAVICULAR JOINT
Rotator cuff tear–Glenohumeral joint spared
TOTAL JOINT INVOLVEMENT
Rheumatoid–Symmetric
NORMAL JOINT SPACE
Hydroxyapatite crystal deposition disease
Chapter 01_1_32_F 2/20/06 2:32 PM Page 30
NAMES TO KNOWUPPER EXTREMITY LOCATION OF INJURY
Mallet Finger Dorsal Base DPBennett’s 1st MC base, intraarticularRolando CommunitedGamekeeper 1st PP ulnar Boxer’s 5th MCColle’s Distal radiusSmith’s Reverse collesChauffer’s (Hutchinson’s) Radial styloidBarton’s Dorsal rimRev. Barton’s Anterior rimNightstick Ulnar shaft isolatedMonteggia Ulna and radial + dislocation (elbow)Galleazzi Ulna and radial + dislocation (wrist)Hill Sach’s Humeral headBankart Glenoid
LOWER EXTREMITY LOCATION OF INJURY
Jones 5th MT baseLisfranc 2-5 MTChoparts Talonavicular and calcaneocuboid
dislocationMaisonneuve Pronation external rotation injury-
proximal fibulaTillaux Anterior tibial tubercleWagstaffe-Lefort Fibular avulsion
SPINE LOCATION OF INJURY
Jefferson C1 lateral massesHangman C2 pars FxClay Shovelers Posterior elementsLefort I Through maxillaLefort II Nasal—inferior orbital rimsLefort III Nasal–orbits
Chapter 1 / Musculoskeletal Radiology 31
Chapter 01_1_32_F 2/20/06 2:32 PM Page 31