RAD III BS

Metastasis

What is this?

- MC malignant tumor of skeleton

- > 40 yo male

- Pain (Worse at night, Intractable)

- Found in Axial skeleton, Pelvis, Skull, Ribs/ Sternum, Proximal Long bones

- X-ray: 30-50% bone loss

- Bone Scan: Tech-99

- MRI: Gadolinium

Lytic Mets

What form of Mets is this?

- Moth-eaten permeative

- Male: Lungs

- Female: Breast

Blow out Mets

What form of Mets is this?

- Bubbly, expansile lesion

Blastic Mets

What form of Mets is this?

- Multiple Snowball appearance

- Male: Prostate

- Female: Breast

1. Osteoporosis

2. Mets

3. Multiple Myeloma

DDx for VB path compression Fx?

1. Blastic Mets = Normal shape/ anterior body

2. Pagets = Squared off, enlarged

3. Hodgkin's Lymphoma = Anterior scalloping

DDx for Ivory VB?

Pedicle destruction

What is this?

- MC in Mets

- Lower T/S & L/S

Pedicle agenesis

What is this?

- More sclerotic pedicle

Extrapleural Sign/ "Cat under rug"

What is this?

Non-traumatic avulsion lesser trochanter

What is this?

Cookie bite erosion

What is this?

Multiple Myeloma

- MC primary bone tumor

- ↑ IgG, M Spike, Bence Jones Proteinuria

- Weight loss/ Cachexia, Anemia, Generalized osteoporosis

What is this?

- 50-70 yo, Black male

- Pain

- Skull, Spine, Humerus, Femur

Plasmacytoma

- Local form of MM

- 70% will develop MM

What is this?

- >50 yo, Black male

- Pain

- Mandible, ilium, VB, ribs, prox femur, scapula

Osteosarcoma

- 2nd MC primary malignancy

- Can arise from areas of pre-existing bone disease (Paget's, FD, Osteochondroma or areas treated w/ radiation)

- Cumulus cloud appearance

- Spiculated/ Codman's

- Cannonball Mets

What is this?

- 10-25 yo, Male

- Pain (Painful swelling, Hx of antecedent trauma)

- Metaphysis around the knee (Distal femur, proximal tibia) + Proximal Humerus

Chondrosarcoma

- 3rd MC primary malignancy

- Can arise from pre-existing benign cartilaginous lesion (osteochondroma/ enchondroma)

- Scattered calcifications (Ring/ Arc)

- Laminated/ Spiculated

What is this?

- 40-60 yo, Male

- Pain (Minor palpable swelling, can be asymptomatic)

- Metadiaphyseal - Pelvis, proximal & distal femur, humerus, ribs, scapula, proximal tibia, hand, foot, spine

Ewing's Sarcoma

- 4th MC primary malignancy

- Small round cell blue tumor

- 5-20 yo = Peripheral skeleton

- 20-35 yo = axial skeleton

- Laminated/ Codman's

- Whisker's effect

- Cannonball Mets

What is this?

- 10-25 yo, White male

- Pain (Local + Swelling)

- Diaphyseal - Femur, Innominate, Tibia, Fibula, Humerus, L/S + Sacrum

Fibrosarcoma

- Rare collagen tumor of bone

- Can arise from pre-existing lesions

- Lichtenstein's Rule - IF you can't ID the primary lesion = Fibrosarcoma

What is this?

- 30-50 yo

- Pain (Local pain + swelling of long duration)

- Metaphyseal around knee joint

Chordoma

- Rare primary malignancy from notochordal remnants

- MC primary Sacral tumor

- Crosses IVD, involving adjacent spinal segments

- Hot bone scan

- Sacrococcygeal lesion will have thin outer calcified rim

What is this?

- 30-70 yo

- Pain (From mass effect)

- Ends of axial skeleton (Sacrococygeal Jxn, Spheno-occipital Jxn, VB)

Hodgkin's Lymphoma

- Reed-Sternberg Cells

- Enlarged nodes of neck/armpit

- Lytic lesion + Ivory VB w/ Anterior body scalloping

- Mediastinal masses

What is this?

- 20-40 yo

- Pain after drinking alcohol

- Lower T/S + Upper L/S

Synovial Sarcoma

- Malignant ST tumor

- NEAR JT BUT NOT IN JT ITSELF

What is this?

- 15-40 yo

- No pain

- ST mass near Knee, hip, ankle jt

Childhood Leukemia

- MC Childhood malignancy

- Acute lymphoblastic = common form

- Generalized osteoporosis

- Radiolucent metaphyseal bands in long tubulur bones

What is this?

- 2-5 yo

- Pain (joint pain/ fever)

- Widespread

Hypertrophic Osteoarthropathy

- Periosteal rxn w/o underlying bone lesion

- Due to bronchogenic carcinoma

Triad:

- Digital clubbing

- 2 fingers together = Scamroth

- Symmetrical arthritis

- Metahyseal/ Diaphyseal periostitis

What is this?

Triad:

- Digital clubbing

- 2 fingers together = Scamroth

- Symmetrical arthritis

- Metahyseal/ Diaphyseal periostitis

Giant Cell Tumor/ Osteoclastoma

- MC neoplasm of patella & sacrum

- Follow-up with CT if cortex is broken

- Donut scan

What is this?

- 20-40 yo

- Pain (local)

- Metaphyseal - Distal femur/ radius, Proximal tibia/ humerus

- Extends to subarticular surface (Patella & Sacrum)

Osteochondroma

- MC benign Appendicular SK

- Bony exostosis

- Sessile = Flat; Humerus & Scap

- Pedunculated = Project away from jt; Coat hanger/ Cauliflower spine

What is this?

- < 20 yo, Male

- No pain

- Diaphyseal - Femur, humerus, tibia, ribs, scapula (anywhere off growth plate)

HME

- Multiple osteochondroma

- B/l + symmetric

- Bayonette deformity - Short ulna/ Bowing radius/ Sublux radioulnar jt

What is this?

- < 20 yo, Male

- No pain

- Short ulna/ Bowing radius/ Sublux radioulnar jt

Hemangioma

- MC benign Axial SK

- Capillary - Flat bones

- Cavernous - VB & Skull

- Corduroy cloth/ Jail bar/ Striated VB

- Spoked wheel = frontal bone

What is this?

- > 40 yo, Feale

- No pain

- Spine & Skull

Osteoma

- MC benign Nose & paraspinal sinuses

- Smaller than 2cm

What is this?

- 30-60 yo

- Pain (Chronic HA, sinusitis)

- Frontal & Ethmoid sinuses

Enostoma/ Bone Island

- Brush border = Jagged border

What is this?

- Any age

- Asymptomatic

- Pelvis, but can happen anywhere

Osteopoikolosis

- Multiple enostoma concerntrated around jt space

What is this?

- Multiple enostoma concerntrated around jt space

Osteoid Osteoma

- Severe pain, worse at night, relieved by aspirin

- Cortical lesion = Painful & rigid scoliosis + lesion on concave side

- < 1 cm nidus surrounded by reactive sclerosis

What is this?

- 10-25 yo, male

- Pain (Relieved by aspirin)

- Cortical - Femur, Tibia, Neural arch

Osteoblastoma

- Larger version of osteoid osteoma

- Local pain, worse at night, NOT RELIEVED BY ASPIRIN

- Expansile lesion, >2cm nidus, no reactive sclerosis

What is this?

- < 20 yo

- Pain (Not relieved by aspirin)

- Neural arch

Enchondroma

- MC benign hand & foot

- Pain + proximity to axial skeleton = malignant degen

- Well defined, endosteal scalloping, calcifications

What is this?

- 10-30 yo

- No pain until trauma

- Metaphyseal - Hands & feet, phalanges, metacarpals, femur/ tibia, humerus, ribs

Ollier's

- Multiple Enchondromas

What is this?

- 10-30 yo

- No pain until trauma

Maffuci

- Multiple Enchondromas + Hemangiomas (ST Calcifications)

What is this?

- 10-30 yo

- No pain until trauma

Chondroblastoma AKA Codman's tumor

- Pain refers to adjacent jt

What is this?

- 10-25 yo, Male

- Pain (referred to adjacent jt)

- Epiphyseal/ Apophyseal - knee, hip, shoulder

NOF

- 8-20 yo, male

- > 2 cm

- Expansile lesions may be symptomatic + path fx

What is this?

- 8-20 yo, Male

- Asymptomatic

- Metaphyseal - Distal tibia

FCD

- 4-8 yo, male

- < 2 cm

- lesions may be symptomatic + path fx

- lucent defect in cortex → Sclerotic during healing

What is this?

- 4-8 yo, male

- Asymptomatic

- Metaphyseal/ Diaphyseal - Distal femur

Simple Bone Cyst

- Active = Metaphyseal

- Latent = Mid diaphyseal

- Central, Expansile lesion

- Fallen fragment sign/ Hinged fragment sign

What is this?

- 3-14 yo, male

- No pain until trauma

- Metaphyseal - Humerus/ proximal femur

ABC

- MC clavicle tumor

- Crosses epiphyseal plate

- Finger in balloon sign

- Fluid-fluid level

- Blown out

What is this?

- 5-20 yo, Female

- Pain

- Metaphyseal - Femur/ TIbia, Neural arch, SP/ T, lamina, T/S, L/S, Clavicle