Skeletal Pathology

Osteogensis Imperfecta

genetic disorded causing weak bones due to decreased collagen

Osteogensis Imperfecta is also known as

brittle bones disease

types of Osteogensis Imperfecta

I - most common

II - most severe, child usually dies at birth

III - most severe for children who survive birth

IV - intermediate severity, high survival rate

treatment for Osteogensis Imperfecta

there is no cure

symptoms can be treated with

• hydrotherapy

• surgery - placing pins

• braces and protective devices

radiograpohic apperance of Osteogensis Imperfecta

bone deformities

the bone cortext is thin and porous

technical considerations for patients with Osteogensis Imperfecta

decrease technique by up to 50%

extreme care when positioning as to not break a bone

Achondroplasia

genitic disorder that effects cartilage growth

• endochoncral ossification

• short arms and legs with normal size trunk and skull

the most common form of dwarfism

radiographic apperance of Achondroplasia

makes long bones appear short and thick with widened metaphysis

treatment for Achondroplasia

there is no cure

treatments are to manage symptoms

Osteopetrosis

genitic disease marked by abnormally dense bones

• bones are abnormally heavy and compact, but are brittle

due to decreased osteoclasts

radiographic apperance of Osteopetrosis

marble bone - increase in bone density

technical considerations for patients with Osteopetrosis

increase technique

treatment for Osteopetrosis

no cure

hematopoietic stem cell transplants can help introduce more osteoclasts to help reduce bone mass

syndactylism

genetic disorder

failure of the fingers or toes to separate

treatment for syndactylism

surgery to separate fingers

polydactylism

genetic disorder

the presence of extra digits in the hand or foot

treatment for polydactylism

surgicla removal of the extra digit

talipes equinovarus is also known as

clubfoot

talipes equinovarus

congenital disorder that causes malformation of the foot in utero. the ankle ligaments are formed too tight which causes:

• toes to pull medially

• plantar surface of foot to face medially

more common in males

diagnoses using US during pregnancy

treatments for talipes equinovarus

braces

surgery

congenital hip dysplasia is also known as

developmental dysplasia of the hip (DDH)

congenital hip dysplasia

results from incomplete articulation of the femoral head with the acetabulum

is diagnoses by a doctor after birth

congenital hip dysplasia causes

idiopathic

theories are

• genetic

• breach births

• 1st pregnancies

• low amniotic fluid

radiographic apperance of congenital hip dysplasia

AP pelvis image apperas almost normal, with a slightly large joint space

Frog lateral image shows hip is dislocated

treatment for congenital hip dysplasia

treatment is dependent on the child’s age and severeity of the hip damage

• soft bracing

  • Pavlic harness

• casting

  • spica cast

• surgery

  • periacetabular ostomy

what regions can develop an extra rib

cervical or lumbar

sina bifida

congenital disorder

posterior defect of the spinal canal resulting from failure of the posterior elements to fuse properly

degree of severity varies

caused by low folic acid in utero

diagnosed via US during pregnancy

types of spina bifida

spina bifida occulta

meningocele

myelomeningocele

spina bifida occulta

mildest type of spina bifida

defect where the lamina are supposed to fuse

meningocele

modereate type of spina bifida

membrane surrounding the spinal cord pushes through the opening

forms a fluid-filled sac

myelomeningoecle

severe type of spina bifida

spinal cord and meningies protrude

hydrochephalus

increasd fluid in the brain

80-90% of children with spina bifida with develop and need shunts placed to treat

how is spina bifida treated

surgery while in utero

osteomyelitis

bacterial inflammation of the bone and bone marrow

caused by infectious organisms that reach the bone

spread through the blood stream

common causes of osteomyelitis

open fractures

surgery

diabetes

radiographic apperance of osteomyelitis

inital stages:

• subtle area of metaphyseal lucency

later stages:

• bony destruction

• moth eaten apperance

treatment for osteomyelitis

medications (6-18 months of daily injections)

surgery (amputation)

rheumatoid arthritis

chronic autoimmune disease with inflammatory changes occuring throughout the body’s connective tissue

treatment of rheumatoid arthritis

no cure

steroids and occupational therapy to treat symptoms

osteoarthritis is also known as

degenerative joint disease (DJD)

osteoarthritis

non-inflammatory joint disorder

gradual deterioration of the articular cartilage

most common type of arthritis

considered a normal part of aging

radiographic apperance of osteoarthritis

earlist radiographic findings:

• nearrowing of the joint spaces

• development of small bony spurs(osteophytes)

gout or gouty arthritis

a form of inflammatory arthritis

develops in people with high levels of uric acid in the blood

mostly affects:

• DIP

• PIP

• MCP

• MTP - most common

long term complications include formation of kidney stones

radiographic apperance of gout

radiographic changes only occur late in the disease and only after repeated attacks

clumps of crystals around the cortex of bone

joint effusion

periarticular swelling

treatment of gout

two types of medications

• reduce inflammation and pain

• prevents gout complications by lowering uric acid levels

osteoporosis

natural part of aging that develops slowly

decrease in bone density

• old bone is removed faster than new bone is made

compression fractures are common with this

radiographic apperance of osteoporosis

cortical thinning

more radiolucent than normal bone

technical considerations for pts with osteoporosis

decrease kVp to get a higher contrast image

osteomalacia

softening of bone

caused by a lack of vitamin D

rickets

a type of osteomalacia in children caused by a lack of calcium and vitamin D in the tissues and a failure of bone tissue to calcify

radiographic apperance of osteomalacia

bowing of the weight-bearing bones

softening of vertebral bodies leads to kyphosis and more prone to fractures

treatment of osteomalacia

if caught early (Rickets) can be reversed with vitamin D and calcium supplements

if caught later is treated with surgeries to fix bowed legs

Paget’s disease

one of the most common chronic metabolic skeletal diseases

disorder of the bone remodeling process

unknown cause

more common in the elderly

radiographic apperance of Paget’s disease

most common site is the pelvis

irrecgular sclerotic bone and cortical thickening

cotton-wool apperance

treatment for Paget’s disease

no cure

anti-inflammatories and medications to help symptoms

acromegaly

endocrine disorder caused by a disturbance of the pituitary gland

slowly progressive disease

caused by tumor on pituitary gland that secretes excess growth hormones

treatment of acromegaly

transsphenoidal surgery to remove tumor

hormone medications

spondylolysis

a stress fracture in the pars interarticularis

most commonly L5-S1, but can be anywhere

most commonlycaused by sports injury (gymnastics, football, etc)

may cause pain and spondylolisthesis

spondylolisthesis

forward movement of one vertebrea upon another

commonly due to a defect in the pars interarticularis

types of spondylolisthesis

1. dysplastic - congenital

2. isthmic - stress fx

3. degenerative - degeneration due to aging

4. traumatic - due to accident

5. pathological - other pathology like cancer causes weakening of the zygapophyseal joint

diagnosis of spondylolisthesis

XR

CT

MRI

treatment of spondylolisthesis

physical therapy

NSAIDS

surgery

• spinal decompression

  • HNP - discectomy (remove part of the disc)

  • narrow foramen - foraminotomy

  • spinal stenosis - laminectomy

  • lateral recess stenosis - gill fragment (chip of broken off bone) removed with facetectomy

• alignment

• stabilization

benign bone tumors

can occur in any bone

• most common in the axial skeleton

can be agressive and destroy bone

• osteolytic

can be agressive and build extra bone

• osteoblastic

most common benign bone tumor types

osteochondroma

osteoma

endochondroma

giant cell tumor

osteochondroma

most common benign bone tumor

an overgrowth of cartilage near the growth plate

most commonly in long bones in the leg, pelvis, or shoulder blade

exostosis - excessive bone growth

radiographic apperance of osteochondroma

extension coming out of the bone

osteoma

commonly located in the skull, sinuses, and mandible

radiographic apperance of osteomas

appear as extremely dense, round lesions that are rarely larger than 2 cm in diameter

endochondromas are also known as

enchondromas

endochondromas

slow growing benign cartilaginous tumors in the medullary canal

usually affects small bones of the hands and feet

radiographic apperance of endochondromas

translucent expansion in the bone

osteoclastomas are also known as

giant cell tumors

osteoclastomas

typically arises at the metaphysis and extends down to the epiphysis of long bones

next to the joints

idiopathic

radiographic apperance of osteoclastomas

lucent lesion in the metaphysis

are malignant or benign bone tumors more common

benign

types of malignant bone tumors

osteosarcomas

Ewing’s sarcoma

chondroscarcoma

multiple myeloma

osteosarcoma

most common malignant bone tumor in youths

occurs in growing bones

• ends of long bones

overgrowth of new bone when it is not needed causes a mass

radiographic apperance of osteosarcoma

sunburst appearance

treatment for osteosarcoma

depends on how much of the long bone is damaged

prosthesis

• depends on the tumor and the size

amputation

• unavoidable if the cancer is affecting surrounding blood vessels and nerves

• artificial limbs can be fitted after surgery

Ewing’s sarcoma

rare and extemely malignant

occurs at a younger age (5-15 years old)

cells develop a DNA change causing increased bone production and bone thickening

treatment for Ewing’s sarcoma

surgery

chemo

radiographic apperance of Ewing’s sarcoma

usually begins in the shaft of the bone

lamellated appearance

layered “onion peel” appearance

chondrosarcoma

cancer develops from chondroblasts

tumor cells produce excess cartilage

radiographic apperance of chondrosarcoma

damage to the bone as the cancerous cells expand

multiple myeloma

affects the plasma cells in the bone marrow

crowds out healthy blood cells

• causes a decrease in RBCs, WBCs, and platelets

radiographic apperance of multiple myeloma

punched out osteolytic lesions scattered throughout the skeletal system

technical considerations for multiple myeloma

decreased technique

bone metastases

virtually any type of cancer can metastasize to the bone

• majority are from breast and prostate cancers

NM used to diagnosis

classifications of bone metastases

osteolytic (75%)

osteoblastic (25%)

radiographic apperance of osteolytic bone metastases

destruction of the bone

margins of the lucent lesions are irregular and poorly defined

radiographic apperance of osteoblastic bone metastases

formation of new bone

areas of increased density