Radiology 3 Week 8

What is the AKA of neurofibromatosis?

Von Recklinghausen disease

What is the term for NF with tumors of the peripheral nerves?

NF-1

What % of NF is NF-1?

90%

What is the term for NF with bilateral acoustic neuromas?

NF-2

What is the AKA of NF-2

Schwannomatosis

T or F: NF-2 forms neurofibromatomas

False (only NF-1 does)

What is the classic tired of NF?

Cafe au lait spots

Fibroma molluscum

Osseous deformities and lesions

What type of cafe au lait spots are found in NF?

Smooth bordered / Coast of California

What is the term for multiple soft, elevated cutaneous tumors?

Fibroma molluscum (very large, innervated skin tags)

What is the name sign of fibroma molluscum?

Incomplete border sign

What gender is NF more common in?

Neither

What is the diagnostic finding of NF?

6 or more cafe au lait spots measuring 1.5 cm or more

What % of the normal population has one or two cafe au lait spots?

15%

What % of the normal population has more than 2 cafe au lait spots?

1%

What is the most common cutaneous manifestation of NF?

Fibroma molluscum

What is the term for thick, large soft tissue folds in NF with enlargement and swelling?

Elephantiasis Neuromatosa

What is the term for a benign tumor of peripheral nerves which presents as a subcutaneous mass which feels like a bag of worms?

Plexiform neuroma

What is the presenting sign resulting from a temporal lobe herniation through a deficient posterior surface of the orbit in NF?

Pulsating exopthlamos

What are the findings of spinal involvement in NF?

Paraplegia

Scoliosis/kyphoscoliosis*

Atlantoaxial subluxation

What % of NF degenerates malignantly?

5%

What is the name sign of a deficient posterior orbit in NF?

Bare orbit

What is the most common sign of NF on x-rays?

Kyphoscliosis (50%)

What % of NF patients develop skeletal lesions?

50%

What is the most common finding of kyphoscoliosis in NF?

acutely angular and short segmented (5-7 vertebra), usually affecting the lower thoracic spine

What is the finding of NF in the vertebral body?

Posterior scalloping

What are the two types of scalloping in NF?

Posterocentral scalloping

Eccentric unilateral scalloping

What causing posterocentral scalloping in NF?

Dural ectasia

What is the name sign of eccentric scalloping at a single level, creating an enlarged IVF in NF?

Dumbell vertebra

T or F: Posterocentral scalloping affects multiple levels while eccentric unilateral scalloping affects a single level?

True

What causes posterior mediastinal masses in NF?

Intrathoracic meningocele

What side are menignoceles more common on?

Lateral side on the right

Which bone is aplastic in bare orbit sign in NF?

Sphenoid

What is the term for defect in the lambdoidal suture, representing underlying hypoplasia of bone (not neurofibromatosis lesion)?

Asterion defect

What bony landmark is often hypoplastic in astern defect?

Mastoid

What is the name sign of scalloping irregularities of the ribs in NF?

Twisted Ribbon appearance

What % of NF has pseudoarthrosis of the tibia?

50%

What conditions can cause posterior VB scalloping?

Neurofibromatosis

Achondroplasia

Ehler's danlos syndrome

Marfan's syndrome

Acromegaly

What type of benign bone lesion is often found in assocaition with NF?

Non-ossifying fibromas

What is the term for local overgrowth of the skeleton and soft tissue structures of the extremity in NF?

Focal gigantism

What can create hypertension in NF?

Renal artery stenosis

What is a secondary effect of renal tubular dysfunction in NF?

Osteomalacia

What is the term for increased size in one digit in NF?

Focal gigantism / Macrodactyly

What is the diagnostic finding of NF-2?

Bilateral vestibular schwannomas

What is the term for a unilateral lesion at the cerebellopontine angle?

Meningioma

What is the term for infection in bone?

Osteomyelitis

What is the term for infection in a joint?

Septic Arthritis

What is the term for inlammation/infeciton ofin the spine?

Spondylitis

What is the term for inflammation/infection of the IVD?

Discitis

How long does it take to see changes of osteomyelitis on x-ray?

10-21 days

How long does it take to see changes of osteomyelitis on MRI?

1 hour

How long does it take to see changes of osteomyelitis on Bone scan?

1-3 days

What is the most common cause of all bone and joint infection?

Staphylococcus Aureus (90%)

What are the methods of spread of osteomyelitis?

Hematogenous (MC)

Contiguous

Direct Implantation

Postoperative

How long does it take for osteomyelitis changes to be visible in the appendicular skeleton?

7-10 days

How long does it take for osteomyelitis changes to be visible in the axial skeleton?

21 days

What is the presentation of suppurative osteomyelitis in young patients?

Acute systemic symptoms

What is the presentation of suppurative osteomyelitis in older patients?

Variable, chronic symptoms

What is the most common demographic of suppurative osteomyelitis?

Males (3x) 2-20 yo

Which bones are most commonly affected by suppurative osteomyelitis?

Long tubular bones

Femur MC

What organism are sickle cell patients predisposed to infection from?

Salmonella

What organism are drug addicts predisposed to infection from?

Pseudomonas

What joints are drug addicts predisposed to infection in?

The "S" joints:

Spine

Sacroiliac

Symphysis pubis

Sternoclavicular

(Mainliner syndrome)

What is the term for necrotic cortical or medullary bone in suppurative osteomyelitis?

Sequestrum

What is the term for a cortical collar of new bone in suppurative osteomyelitis?

Involucrum

What causes involucrum formation in suppurative osteomyelitis?

Chronic periosteal reaction that walls off the organism

What is the term for a draining sinus in suppurative osteomyelitis?

Cloaca

What is the term for malignant degeneration of squamous cell lining of a cloaca?

Marjolin's ulcer

What are the soft tissue alterations of suppurative osteomyelitis?

Elevated fat planes

Obliterated fat planes

Increased Density

Parapsinal edema

What is the earliest radiographic sign of suppurative osteomyelitis

swelling of the deep soft tissues usually around the metaphysis in infants and children

What is the term for bone destruction in suppurative osteomyelitis, usually metaphyseal in origin?

Moth-eaten

What type of periosteal responses are seen in suppurative osteomyelitis?

Solid

Laminated

Codman's triangle

What is the term for joint space destruction in suppurative osteomyelitis?

Osseous ankylosis

What is indicated by loss of disc space with thinning and blurring of the end plates?

Spondylodiscitis

T or F: septic arthritis often involves multiple joints

False (a single joint involvement is the rule)

What is the most common route of contamination of septic arthritis?

Hematogenous spread (or direct traumatic implantation)

What is the most commonly associated organism in septic arthritis?

Staphylococcus aureus

What are the clinical signs of septic arthritis?

Chills

Fever

Edema

Pain and redness

What are the lab findings of septic arthritis?

Elevated ESR and WBCs

What is the behavioural finding of septic arthritis in the weight bearing joints?

Altered gait

What are the risk factors for septic arthritis?

Bacteremia

Advanced age

Immunocompromised state

RA

Intra-articular injections

Prosthetic joints

Joint trauma (puncture wounds)

Skin fragility

Which joints are most commonly affected by septic arthritis?

Shoulder

Knee

Hip

What is the finding of the fat folds due to joint effusion in septic arthritis?

Distortion of the fat folds

What is the term for increased distance between the femoral head and pelvic tear drop?

Waldenstrom's sign

T or F: Waldenstrom's sign is diagnostic for septic arthritis in the hip

False (non-specific)

What is indicated by subhcondral/subarticular loss of bone on both sides of a joint?

Infection

T or F: Bony ankylosis is common in septic arthritis

False (rarely occurs)

What % of suppurative osteomyelitis occurs in the spine?

2-4%

What demographic most commonly gets suppurative osteomyelitis in the spine?

Males 40-50 yo

What part of the spine is suppurative osteomyelitis most common in?

Lumbar

What is the most common infectious agent in spinal suppurative osteomyelitis?

Staph aureus

What is the most likely history finding of spinal suppurative osteomyelitis?

History of recent primary infection (in the throat, urinary tract, etc) (or surgery)

What are the symptoms of suppurative osteomyelitis?

Constant back pain of insidious onset

Fever (rarely)

Elevated ESR

What age group still has a vascular pathway to the IVD?

<20 yo

Where may initial infection be in suppurative osteomyelitis of the spine in children?

IVD

Where is the initial infection typically in suppurative osteomyelitis of the spine in adults?

Anterior vertebral endplate

What is the term for a localized form of suppurative osteomyelitis?

Brodie's abscess

What is the clinical presentation of Brodie's abscess?

Localized limb pain, often nocturnal and relieved with aspirin (Ddx osteoid osteoma)

What demographic is Brodie's abscess seen in?

Boys with unfused epiphyseal plates

What bones are most affected by Brodie's abscess?

Metaphysis of tubular bones:

Tbiia (distal then proximal)

Femur

Fibula

What are the name signs of the serpiginous radiolucency with no visible matrix in Brodie's abscess?

Halo / doughnut rim of heavy reactive sclerosis