Radiology Final Non-traumatic X-ray

2

How many x-ray views do you typically need?

X-ray

What type of imaging is best used to visualize bone cortex?

True

T/F: X-rays can detect significant soft tissue swelling?

STS

What is the arrow pointing to?

Bone density

Amount of bone mineral in bone tissue

Osteoblastic metastases sclerosis

Diffusely increased density could be indicative of ....

Focally increased density

Localised osteoblastic metastases/tumor, Avascular necrosis of bone (such as in hip), and Paget disease or CCPD would look like what

Diffusely decreased density

Osteoporosis and Hyperparathyroidism would look like ...

Focally decreased density

Localized osteoclastic metastases, multiple myeloma, osteomyeloma would look like ...

False! Metastases to bone are more common

T/F: Metastases to bone are less common than primary bone tumors?

Prostate CA

What is the MC cause in older men of osteoblastic metastasis?

Diffuse

Image on the left is normal, is the image on the right diffuse or local?

Local

Osteoblastic/sclerotic bone lesion - is this diffuse or local?

Increased

AVN - in later stages, will the lesion appear as increased or decreased density?

MRI

What imaging test is most sensitive for detecting AVN?

AVN

Legg-Calve-Perthe's disease is one of the many causes of

Crescent sign

AVN of femoral head- What is the name of this sign?

Paget's disease

This is a chronic disease of bone characterized by varying degrees of increased bone resorption and increased bone formation

1. thickening of the cortex

2. coarsening and thickening of the trabecular pattern

what are the 2 hallmarks of Paget's disease?

Conventional radiography (x-ray)

What radiologic test would you use to diagnose Paget's disease?

Paget's disease ? (not sure can someone confirm)

Identify

CCPD seen in pseudogout

Pls identify

Osteoclastic

Hyperparathyroidism leads to an increase in _______ activity

Focal lesion

What are the white arrows pointing to?

Focal lesions

These are examples of ...

Geographic

Accurately describe this pattern of bone destruction

Mottled (moth eaten appearance)

Accurately describe this pattern of bone destruction

Permeative

Accurately describe this pattern of bone destruction

Multiple Myeloma

What is the most common primary malignancy of bone (marrow) in adults?

Lytic lesions "punched out"

Multiple myeloma creates what type of lesions?

Diffuse spinal osteoporosis

What is the hallmark of MM?

MM

diffuse lytic lesions in skull - think?

Osteomyelitis

Hallmark on radiograph is destruction of the articular cartilage, release of synovial fluid

Can be both!

Would arthritis be increased or decreased in density on x-ray?

Arthritis

Joint space narrowng think

Joint

Is arthritis more of a joint or bone disease?

Osteophyte formation

What is the hallmark of hypertrophic arthritis?

Degenerative joint disease (DJD)

MC type of arthritis?

excessive wear and tear

MC cause of DJD

OA

68 YOM pt comes in complaining of joint pain and this is what the x-ray shows. Dx?

Erosive arthritis

RA, gout, psoriatic arthritis, and ankylosing spondylitis are examples of ...

Rheumatoid arthritis

45 YOF presents with joint pain involving proximal joints of hands and wrists, symmetrically, bilaterally. You also see ulnar deviation of the fingers at the MCP joints, subluxation of the MCP joints as well as swan neck and boutonniere deformities. Most likely dx?

Boutonniere and Swan neck deformity

What do you see?

Gout

Calcium urate crystal deposition think ...

Metatarsal phalangeal joint of great toe

Where (anatomically) does gout MC affect?

Gout

Hallmark of this disease is sharply marginated, juxtaarticular erosion that tends to have a sclerotic border ("rat bites")

Gout

Please identify most likely dx

Pencil in a cup

What sign is this?

Psoriatic arthritis

Most likely Dx here?

Bamboo spine - Ankylosing spondylitis

What's this sign and what dx?

Ankylosing spondylitis

Louis, 25 YOM, presents with complaints of lower back pain and stiffness. X-ray came back with Bamboo spine deformity, fusion of lumbar and sacroiliac joints. Pt also tested positive for HLA-B27. Hx of UC. Most likely Dx?

Normal L-spine

Please identify

MRI

What is the test of choice for spine diseases?

Scottie dog sign

Oblique view- what's this sign?

Degenerative disk disease

spaces above and below are not uniform

Compression fracture

Please identify

Conventional spine radiographs (X-ray)

Study of first choice for compression fractures

Anterior and Superior

Osteoporotic compression fractures usually involve the _____ and _____ aspects of the vertebral body

Compression fracture

Identify

Spinal stenosis

Narrowing of the spinal canal

Cervical and lumbar areas

Where is spinal stenosis most common

Flexing

Neurogenic claudication is relieved by ______ the spine

X-ray

First test for spinal stenosis

MRI

Test of choice for spinal stenosis

Complete fracture

Identify

Fracture

disruption in the continuity of all or part of the cortex of a bone

Incomplete fracture

Only part of the cortex is fractured

Complete fx

Fracture through and through

True

T/F: in growing bone there are added calcifications because of the growth plate involvement

Type 3

Fracture below the growth plate - Salter Harris classification?

False! Type 3 can develop arthritic changes or plate fusion

T/F: Salter Harris fx Type 1-3 heal well

Type 4 and 5

Which salter harris fx type is more likely to develop early fusion of the growth plate with angular deformities and shortening of the bone when healing

Type 3

Fracture of epiphyseal plate and epiphysis itself

Klein's line

What is the name of line the arrow is pointing to

Trethowan sign

What is this sign called

early slipped upper femoral epiphysis

What is Klein's line used to detect?

Type 2

MC type of SH fx?

Corner sign

Type 2 SH fx produces what sign

Type 2

Fracture of epiphyseal plate and metaphysis

SH Type 2 (A= above the growth plate)

Fx type?

Type 3

Which SH type can cause premature closure of the growth plate?

Type 3 (L=beLow the growth plate)

Fx?

Type 4

Fracture of epiphyseal plate, metaphysis, and epiphysis

Type 4

Premature and asymmetric closure of the growth plate - can cause leg length differences

Type 4

Fx?

Type 5

Crush type of fx

Type 5

SH fx?

Accidental

Are SH fx accidental or intentional?

Metaphyseal corner fractures

Rib fx

Head injuries

3 injuries that should raise your suspicion for child abuse?

Metaphyseal corner fx

Identify

Rib fx

identify

Child abuse

3 y/o pt with broken sternum

1

Spiral fracture in children less than ___ y/o is child abuse