1. Aggressive vs NonAggressive (Musculoskeletal Interpretation)

anatomy and alignment (normal and abnormal)

Interpret MSK radiographs via an ABC...E approach.

What does A stand for?

bones

Interpret MSK radiographs via an ABC...E approach.

What does B stand for?

cartilage

Interpret MSK radiographs via an ABC...E approach.

What does C stand for?

everything else (soft tissue, lymph nodes)

Interpret MSK radiographs via an ABC...E approach.

What does E stand for?

soft tissue

What opacity is cartilage?

no, interpret via bone changes where the cartilage attaches

So... if cartilage is soft tissue opacity... Can I really evaluate it on radiographs?

osteoproliferation

What is the term for "bone production"?

periosteal, periarticular, sclerosis

What are the three types of bone production?

periosteal

Which type of bone production happens around the bone

periarticular

which type of bone production happens around the joints

medullary, subchondral

Sclerosis is new bone formation in the _________ or _________ cavity

osteopenia, metabolic/nutritional disease, disuse

What is generalized bone loss called and what are some things that cause it? (2 causes)

osteolysis, infection, tumor, cyst

What is focal bone loss called, and what are a few causes? (3 causes)

neoplasia, osteomyelitis

What are the two primary diagnosis for aggressive lesions

primary bone tumor, metastatic lesions

What are some aggressive neoplasias in the bone?

fungal, bacterial

What are some examples of an osteomyelitis

bone cyst, degenerative joint disease, fractures (most), juvenile/developmental bone disease

What are some causes of non aggressive bone lesions?

epiphysis

Which part of the bone is indicated by the bracket in blue?

metaphysis

Which part of the bone is indicated by the bracket in pink?

diaphysis

Which part of the bone is indicated by the bracket in green?

size, shape, number, position, opacity, margination

Quick review, what are the six core roentgen signs?

destruction of the cortex, periosteal reactions, zone of transition

What are the three things to look for to determine if a bone lei=sion is aggressive or not?

periosteal reactions

__________________: activity based on appearance of the margin of the periosteal reaction

healing, stimulation, elevation

Periosteal reactions are a _______ response that occurs by _______ or _______ or the periosteum from the cortex of the bone

activity, type

periosteal reactions are classified in terms of _____ and ________

irregular

Periosteal reactions can be smooth or irregular.... ________ indicates that the lesion is more aggressive

smooth, lamellar, collumnar/palisading, spiculated, amorphous

What are the periosteal reaction types from least to most aggressive?

lamellar, cyclic process

Which periosteal reaction has a layered or onion skin appearance?

And what does this indicate?

columnar/palisading

Which type of periosteal reaction has an irregular margin perpendicular to the long axis of the bone?

spiculated

which periosteal reaction has irregular margins that are long, thin, and radiate out at different angles from the cortex

amorphous

which periosteal reaction has no distinct margins, and results from disorganized bone formation often extending far into surrounding soft tissue

spiculated

Which periosteal reaction is this?

amorphous

Which periosteal reaction is this?

smooth

Which periosteal reaction is this?

lamellar

Which periosteal reaction is this?

columnar/palisading

Which periosteal reaction is this?

smooth (upper left), spiculated (centrally)

Which type of periosteal reaction is present here?

codmans triangle

in periosteal reactions, when there is a large disorganized lesion, there are often also areas of smooth solid periosteal reactions at the edges, secondary to the lifting of the periosteum by the more aggressive part oft he lesion.

This is called what?

codmans triangle

What is the abnormality under the main disorganized lesion seen here?

opacity, corticies, trabecular

generalized osteopenia results in a decreased _______, thin _____ and a distinct _______ pattern

less

the [more/less] distinct the margins of a lytic lesion, the more aggressive the process

geographic, moth eaten, permeative

What are three types of focal bone loss, from least to most aggressive?

geographic

What type of bone loss is defined by large areas of distinct/well defined margins?

moth eaten

What type of bone loss is defined by variably sized and shaped areas of lysis?

permeative

which type of bone loss if defined by pinpoint areas of lysis throughout an area of bone?

moth eaten

Which type of lysis?

geographic

Which type of lysis

permeative

which type of bone lysis?

cortical destruction

What has happened here?

discospondylitis

What is this called?

infection (brucella, E coli, staph)

What causes lysis of the endplates adjacent to disc spaces? (discospondylitis)

aggressive; moth eaten, medullary lysis, thinning cortex

Is this aggressive or non aggressive and why?

non aggressive, geographic lesion

Is this aggressive or non aggressive and why?

zone of transition

___________ indicates how distinct the margins are that denote a lytic lesion from normal healthy bone

short

is this a long or short transition zone?

long

is this a long or short zone of transition?

osteosarcoma, chondrosarcoma, fibrosarcoma

what are some primary bone tumors?

monostoic, do not cross joints

Primary bone lesions are typically _______, meaning they ________

metaphysis, away from the elbow and towards the knee (prox humerous, distal radius, distal femur, prox tibia)

Where do you typically see primary bone tumors?

true

true/false: can primary bone tumors be secondary to previous fractures and surgical implants

false; dogs hide a lot of sh*t

true/false: all dogs with primary bone tumors will present with lameness?

genitourinary tumors, pulmonary and primary bone tumors

Which tumors are more likely to metastasize to the bone?

multiple locations (polyostotic) at the diaphysis

Where are metastatic bone tumors usually found?

multiple myeloma

_________: polyostotic lytic lesions that affect flat and long bones and typically look "punched out"

multiple myeloma

What is this?

metaphyseal, joint centric

Where is fungal osteomyelitis usually found?

young/middle aged, large dogs

Who is fungal osteomyelitis usually found in?

histo, blasto, cryptococcus, coccidioides

What typically causes fungal osteomyelitis?

metaphysis or epiphysis in long bones in young patients

Where and who is typically affected by bacterial osteomyelitis

injury or surgery sites

When bacterial osteomyelitis is in adult patients... where is it typically found?

hot, swollen, drainage tract, leukocytosis

What may indicate a bacterial osteomyelitis?

subchondral bone loss

With joint disease, we cant see the cartilage destruction... so where do we look to see if it's aggressive?

neoplasia, septic arthritis, fungal disease

Aggressive lesions in joints can include what? (3 examples)

Right... :,)

Aaaaaaaand here's everything we covered. (I'll save you the trouble of reading her article inside the lecture. It DOES cover everything... but I would only recommend if you just really need it written in a different way)