Radiology 2 EXAM 1

ill-defined

how would you describe the borders of this lesion

well-defined corticated

how would you describe the border of this lesion

well defined, non-corticated

how would you describe the border of this lesion

well defined, partially corticated

how would you describe the border of this lesion

blending

gradual, wide zone of radiopaque transition

invasive

wide zone of RADIOLUCENT transition with few or no trabeculae between lesion periphery and normal bone

dentigerous cyst

odontogenic cyst appearing as a well-defined RL area attached to developing tooth’s CEJ, likely to RESORB ROOTs of nearby teeth

tooth displacement/root resorption, expansion of bone, or asymmetrical follicle

how is a dentigerous cyst differentiated from enlarged follicular space

odontogenic keratocyst (OKC)

unilocular/multilocular well-defined RL with CORTICATED borders and tunneling growth (no expansion)

odontogenic keratocyst (OKC)

grows mesio distally with relatively little buccolingual expansion in body of mandible (expands in ramus and maxilla)

OKC attachs apical of CEJ, no expansion (bucco-lingual), and no resorbed roots

how is an odontogenic keratocyst differentiated from dentigerous cyst

unicystic ameloblastoma

exapansile, unilocular ,RL, displaces/resorbs roots, in young patients

unicystic ameloblastoma

expansile lesion that appears to envelop developing tooth

ameloblastic fibroma

non-hydraulic (not round), unilocular, well-defined non-corticated RL , associated with unerupted tooth with INTACT FOLICLE, in young patients

radicular/periapical cyst

well defined RL lesion at apex of non-vital tooth, loss of lamina dura

from peripery inwards

what is the direction of bone growth when a radicular cyst is healing

healing radicular cyst (bone growth after RCT)

what is the diagnosis?

periapical cemento osseous dysplasia

middle aged black female presents with these incidental findings on a pa, teeth are vital, diagnosis?

lateral periodontal cyst

developmental odontogenic cyst, lateral to the roots of vital teeth, most commonly in mandibular premolar-canine area

botryoid cyst

multilocular variant of lateral periodontal cyst

simple bone cyst (traumatic bone cyst)

well-defined, THINLY corticated, uniform radiolucent lesion, scalloping around roots, NO ROOT RESORPTION or displacement. this is probably a:

anterior border of lesion or floor of maxillary sinus

what could the radiopaque line that the arrows are pointing to be?

complex odontoma

the differential for this incidental finding on an asymptomattic patient should include the following EXCEPT:

lateral periodontal cyst

odontogenic keratocyst

residual cyst

complex odontoma

simple bone cyst/cavity

well defined RL, thinly corticated, scalloping around roots, intact lamina dura, DOES NOT displace teeth

nasopalatine duct cyst

well-defined corticated heart-shaped lesion in the anterior maxilla (may be on midline or slightly off center)

stafne bone defect/ lingual salivary gland depression

a well-defined corticated ovoid RL in the posterior mandible, BELOW IAC

odontogenic Myxoma, Ameloblastoma, CGCG, Hemangioma, OKC, osteoporotic bone marrow (MACHO)

well-defined RL multilocular lesions in differential diagnosis

odontogenic myxoma

likely diagnosis of this lesion

odontogenic myxoma

well-defined RL multilocular lesion in posterior mandible with characteristic “tennis racket” septa

odontogenic myxoma

less well defined in maxilla with “honeycomb appearance”

ameloblastoma

aggeressively EXAPANSILE lesion RL lesion with thick curved septa and “honeycomb” or “soapbubble” appearance

ameloblastoma (root resorption, honeycomb appearance)

most likely diagnosis?

ameloblastoma

likely diagnosis of this AGGRESIVE lesion in maxilla

cental giant cell granuloma (CGCG)

EXAPANSILE multilocular RL lesion with faint wispy septa, more common in anterior mandible, in YOUNGER age group

central giant cell granuloma (CGCG)

septation at right angle to mandibular border likely indicates?

vascular malfomation (hemangioma)

likely diagnosis?

vascular malformation (hemangioma outside IAC)

honeycomb with coarse trabecullation

phleboliths (vascular malfomation in soft tissue)

likely diagnosis of these “bulls-eye" lesions

odontogenic keratocyst (OKC)

perforated inferior border, EXAPANSILE, NO ROOT RESORPTION, likely diagnosis?

odontogenic keratocyst (no root resorption)

most likely diagnosis of this EXANSILE LESION ?

ossifying fibroma

EXPANSILE RO lesion causing tooth and IAC displacement, likely diagnosis?

ossifying fibroma

well defined, thin radiolucent rim, RL to RO EXPANSILE lesion, resorbs roots, loss of lamina dura

maxilla

where do lesions tend to be more aggresive?

focal osteoporotic bone marrow

RL multilocular lesion commonly seen in middle aged women with osteoporosis

acute osteomyelitis

infiltrative, irregular, ill defined radiolucency associated with infection/trauma

osteomyelitis

can present as osteolytic, sclerotic, sequestrum, or with periosteum bone formation (onion skin)

osteomyelitis (periosteal bone formation, fresh EXT site)

what is the likely diagnosis of this ill defined RL

periosteal bone formation

what is indicated by the white arrow

chronic osteomyelitis

bone infection with mostly SCLEROTIC reaction

chronic osteomyelittis

sclerosis, WIDENING of bone, periosteal bone formation, and sequestrum indicates?

chronic osteomyelitis (sclerosis and widening of bone)

what is the likely diagnosis of the lesion in the left mandibule

chronic osteomyelitis (sclerosis, widening, and onion skin)

what is the likely diagnosis of the lesion in the right mandible

osteoradionecrosis

lesion in posterior mandible with LOSS of LINGUAL CORTEX, sequestrum, and HISTORY of RADIOTHERAPY

MRONJ

LARGE sequestrum in jaws associated with antiresorpative medications

sqeamous cell carcinoma arising from soft tissue

soft tissue mass with destuction of bone

squamous cell carcinoma (from soft tissue)

what is the cause of this bone destruction

squamous cell carcinoma

well-defined NON-corticated lesion with CORTICAL DESTRUCTION and NO EXPANSION (unlike cyst/tumor)

irregular PDL widening of tooth #9

identify the anomaly in this image

squamous cell carcinoma (from soft tissue)

likely cause of these “floating teeth”

erosion (vs invasion)

what would smooth borders of malignant lesion indicate?

destruction of left sinus border

what indicates that this soft tissue mass may be malignant (squamous cell carcinoma)

leukemia

no expansion, ill defined patchy RL that can enlarge

non-hodgkins lymphoma

ill defined/ relatively well defined with irrregular NON-corticated INVASIVE border

breast cancer

most common metastasis to POSTERIOR mandible

langerhans cell histocytosis

well defined, NON-corticated SCOOPED out appearance with epicenter at MID-ROOT in YOUNG patient

multiple myeloma

punch out lesion with sharp boundary but NON-CORTICATED

fibrrous dysplasia

blending EXPANSILE RO lesion with ground-glass appearance

osteosarcoma

this “sunrray” periosteal reaction could indicate:

osteosarcoma

RL/RO lesion with IRREGULAR border and DESTRUCTION of CORTEX and lamina dura

chondrosarcoma

INVASIVE, mixed RL/RO, EXPANSILE, root resorption and displacement

osteomyelitis

no history of antiresorpative medications, PAINFUL , what is the likely diagnosis?

left maxillary (loss of sinus floor)

where is the lesion?

squamous cell carcinoma

most likely diagnosis?

metastatic disease

no history antiresorptative medication, no history of cancer, no pain most likely diagnosis?

squamous cell carcinoma

left facial swelling, numbness V2 for 3 months, intraoral soft tissue swelling, most likely diagnosis?

osteomyelitis

osteolytic, small sequestrum, and periosteal bone formation, likely diagnosis?

soft tissue or PDL space

what could a lucent rim around a lesion represent?

root remenants

well defined RO with radiolucent PDL space

hypercementosis

irregular bulbous enlargment of root

hard palate and lingual mandible

locations of tori

palatal tori

what is the likely diagnosis of the radiopacity

lingual tori

likely diagnosis of these radiopaque lesions

exostoses

what are these radiopaque lesions?

bone graft

granular appearrance in edentulous sites with loose fragments of bone within soft tissue

bone graft

what could be the cause of this uniform elevation of the sinus floor

dense bone island/ idiopathic osteosclerosis

localized area of increased radiopacity within the jaw, typically asymptomatic and teeth are VITAL

idiopathic osteosclerosis/ dense bone island (normal PDL space)

most likely diagnosis?

condensing osteitis

most likely diagnosis?

osteoma

benign tumor of bone, well-defined radiopaque, often asymptomatic, and can occur in various locations (MOST COMMON IN SINUS) including the jaw.

osteoma

homogeneously radiopaque lesion with NO PERIPHERAL lucent rim

fibrous dysplasia

poorly defined RO, BLENDING trabecular bone, EXPANDS maintaining anatomical shape

focal COD

most likely diagnosis

florid COD with simple bone cyst

most likely diagnosis

cementoblastoma

RO center mass fused to root with RL RIM, ROOT RESORPTION

cementoblastoma

most likely diagnosis?

compound odontoma

tooth like structures with radiolucent rim, most likely diagnosis

complex odontoma

irrregular mass with enamel density and lucent rim

ossifying fibroma

corticated border with WIDE zone of transition, lucent rim

ossifying fibroma

RO/RL well-defined concentric lesion with WIDE zone of transition, causes ROOT RESORPTION and DISPLACES teeth and IAC

ameloblastic fibro-odontoma (AFO)

non-corticated mixed RL/RO lesion in CHILDREN