Musculoskeletal Radiology 1 / Musculoskeletal Radiology 5 STERNOCLAVICULAR SCLEROSIS STOP SAPHO syndrome Traumatic osteolysis Osteomyelitis/Osteosarcoma Pagets DISTAL CLAVICLE EROSION

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

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General

BASILAR INVAGINATIONPF ROACH

Paget diseaseFibrous dysplasiaRicketsOsteogenesis imperfecta, OsteomalaciaAchondroplasiaCleidocranial dysplasiaHyperparathyroidism, Hurler syndrome

2 Radiology: The Oral Boards Primer

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Chapter 1 / Musculoskeletal Radiology 3

SUBCHONDRAL CYSTSCOORS

CPPD Osteoarthritis Osteonecrosis Rheumatoid arthritisSynovial-based tumors

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ACETABULAR PROTRUSIONPROTrusio

Paget diseaseRheumatoid arthritisOsteomalaciaTrauma

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STERNOCLAVICULAR SCLEROSISSTOP

SAPHO syndromeTraumatic osteolysisOsteomyelitis/OsteosarcomaPagets

DISTAL CLAVICLE EROSIONSHIRT

SclerodermaHyperparathyroidismInfectionRheumatoid arthritisTraumatic osteolysis

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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


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ACRO-OSTEOLYSISPINCH FO

PsoriasisInfectionNeuropathic Collagen vascular diseaseHyperparathyroidismFamilial (Hadju Cheney)Other—polyvinyl alcohol

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CHONDRAL CALCIFICATIONHOGWASH

HyperparathyroidismOchronosisGoutWilson’s DiseaseArthritisPSeudogoutHemochromatosis

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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

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GRACILE BONESNIMROD

NeurofibromatosisImmobilizationMuscular dystrophyRheumatoid arthritisOsteogenesis imperfectaDysplasias

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MADELUNG DEFORMITYHITDOC

Hurler syndromeInfectionTraumaDyschondrosteosisOsteochondromaCongenital–Turner’s syndrome

SHORT METACARPALSBIC PEN

Basal Cell Nevus syndromeIdiopathicChromosomal–Turner’s syndromePseudohypoparathyroidism/PseudoPseduo-

hypoparathyroidism

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Tumors

DIAPHYSEAL LESIONS IN GENERALCEMENT

CystsEnchondromaMetastasisEosinophillic granuloma (EG)Non-ossifying fibroma (NOF)TB/infections

CORTICAL LESIONMOFOS

MetastasisOsteomyelitisFibrosarcomOsteoid osteomaStress fracture

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ILIAC WING LESIONSFibrous dysplaisaUnicameral bone cystChondrosarcomaMets/Myeloma/PlasmacytomaEwings

VERTEBRA PLANAIMELT

InfectionMets/MyelomaEGLymphoma/LeukemiaTrauma

BONY SEQUESTRUMLIFE

LymphomaInfectionFibrosarcomaEG

RIB LESIONFAME

Fibrous dysplasiaABCMetastatic/Myeloma/LymphomaEG/Enchondroma

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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

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SKULL LESIONMEL TORME

MetastasisEGLymphomaTBOsteomyelitisRadiationMetsEpidermoid

TIBIAL LESIONFOAM

Fibrous dysplasiaOsteofibrous dysplasiaAdamantinomaMetastasis

POSTERIOR VERTEBRAL BODY LESIONGO TAPE

Giant cell tumor OsteoblastomaTBABCPaget diseaseEG

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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)

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SACRAL LESIONCAN

Chondrosarcoma/ChordomaABC/GCTNeurofibromatosis

And always Mets/Myeloma/Lymphoma

FLUID-FLUID LEVELHOT MASS

HemangiOmaTelangiectatic osteosarcomaMetastasisABC/GCTSynovial cell Sarcoma

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Arthritis

INFLAMMATORY ARTHRITIS1. RF+

Rheumatoid Arthritis –Symmetric

SLE–Subluxation/nonerosive

Scleroderma–DIP, PIP erosions–Soft tissue Ca2+

–Acroosteolysis

Dermatomyositis–Soft tissue Ca2+

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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

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3. EROSIVE OA

–Dip Joints


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CRYSTAL ARTHRITIS1. DEPOSTION

Gout–Marginal erosions–Overhanging edges–Preserved joint space


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CPPD–ChondroCa2+

–Cysts–2nd and 3rd MCP–SLAC–TFCCa2+

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2. OTHER

Hemochromatosis

Acromegaly

OtherOchronosis

–Disc calcification

Multicentric reticular histiocytosis–Symmetric–No osteopenia

Infection–Crosses Joint Space

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OH MY GOD LESIONSVERY BIZARRE LOOKING GENERALIZEDLESIONS THAT YOU HAVE NO IDEAWHAT IT IS, THINK OF:

Paget diseaseFibrous dysplasiaNeurofibromatosisCharcot joints

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Metabolic

OSTEOPENIAGENERALIZED

Senile osteoporosisOsteomalaciaEndocrine abnormalities

–Cushings (too much)–Hypogonadism (too little)

Anemia/Myelofibrosis/Gauchers –Bone marrow

Congenital–Osteogenesis imperfecta

Hyperparathyroidism

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FOCAL

Reflex sympathetic dystrophy (complex regionalpain syndrome)

DisuseTransient osteoporosisMigratory osteoporosis

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SPINECALCIFICATION OF THE ANNULUS FIBROSIS

Ankylosing spondylitis–Disks unremarkable

Ochronosis–Disks calcified–Abn SI joints

OSTEOPHYTES

DISH–Disks unremarkable–Normal SI joints

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SYNDESMOPHYTES

PsoriasisReiters

MARGINAL OSTEOPHYTES

Spondylosis or degenerative

OSTEOPHYTOSIS

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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

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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

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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


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Musculoskeletal Radiology 1 / Musculoskeletal Radiology 5 STERNOCLAVICULAR SCLEROSIS STOP SAPHO syndrome Traumatic osteolysis Osteomyelitis/Osteosarcoma Pagets DISTAL CLAVICLE EROSION

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