Musculoskeletal Radiology
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1 Chapter 01_1_32_F 2/20/06 2:32 PM Page 1 1 Musculoskeletal Radiology Includes plain film diagnosis in all areas of the musculoskeletal system plus any related special or imaging procedures, including CT, interventional techniques, and MRI. GENERAL CASE CATEGORIES 1. General including Metabolic 2. Congenital 3. Tumors 4. Arthritis From: Radiology: The Oral Boards Primer By: A. Mehta and D. P. Beall Humana Press Inc., Totowa, NJ 1
2 Chapter 01_1_32_F 2/20/06 2:32 PM Page 2 2 Radiology: The Oral Boards Primer General BASILAR INVAGINATION PF ROACH Paget disease Fibrous dysplasia Rickets Osteogenesis imperfecta, Osteomalacia Achondroplasia Cleidocranial dysplasia Hyperparathyroidism, Hurler syndrome
3 Chapter 01_1_32_F 2/20/06 2:32 PM Page 3 Chapter 1 / Musculoskeletal Radiology 3 SUBCHONDRAL CYSTS COORS CPPD Osteoarthritis Osteonecrosis Rheumatoid arthritis Synovial-based tumors
4 Chapter 01_1_32_F 2/20/06 2:32 PM Page 4 4 Radiology: The Oral Boards Primer ACETABULAR PROTRUSION PROTrusio Paget disease Rheumatoid arthritis Osteomalacia Trauma
5 Chapter 01_1_32_F 2/20/06 2:32 PM Page 5 Chapter 1 / Musculoskeletal Radiology 5 STERNOCLAVICULAR SCLEROSIS STOP SAPHO syndrome Traumatic osteolysis Osteomyelitis/Osteosarcoma Pagets DISTAL CLAVICLE EROSION SHIRT Scleroderma Hyperparathyroidism Infection Rheumatoid arthritis Traumatic osteolysis
6 Chapter 01_1_32_F 2/20/06 2:32 PM Page 6 6 Radiology: The Oral Boards Primer SCLEROSIS-GENERALIZED R.S.M.O.P.M.M.P.F. (Regular sex mneumonic) Renal osteodystrophy Sickle cell disease Myelofibrosis Osteopetrosis Pyknodysostosis Mastocytosis Metastasis Pagets Fluorosis OSTEONECROSIS ASEPTIC Anemias Sickle cell disease/sle ETOH/Exogenous steroids Pancreatitis Trauma Infection Caisson s disease
7 Chapter 01_1_32_F 2/20/06 2:32 PM Page 7 Chapter 1 / Musculoskeletal Radiology 7 ACRO-OSTEOLYSIS PINCH FO Psoriasis Infection Neuropathic Collagen vascular disease Hyperparathyroidism Familial (Hadju Cheney) Other polyvinyl alcohol
8 Chapter 01_1_32_F 2/20/06 2:32 PM Page 8 8 Radiology: The Oral Boards Primer CHONDRAL CALCIFICATION HOGWASH Hyperparathyroidism Ochronosis Gout Wilson s Disease Arthritis PSeudogout Hemochromatosis
9 Chapter 01_1_32_F 2/20/06 2:32 PM Page 9 Chapter 1 / Musculoskeletal Radiology 9 Congenital ERLYMEYER FLASK CHONGO Craniometaphyseal dysplasia Hemoglobinopathies Osteopetrosis Niemenn Pick Gaucher s Disease Other METAPHYSEAL BANDS DENSE LINES Lead poisoning Infantile growth arrest Normal, 3 yr LEukemia treated Syphillis LUCENT NORMAL TENDER LOVING CARE Normal (neonates) TORCH Leukemia Chronic illness
10 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer GRACILE BONES NIMROD Neurofibromatosis Immobilization Muscular dystrophy Rheumatoid arthritis Osteogenesis imperfecta Dysplasias
11 Chapter 01_1_32_F 2/20/06 2:32 PM Page 11 Chapter 1 / Musculoskeletal Radiology 11 MADELUNG DEFORMITY HITDOC Hurler syndrome Infection Trauma Dyschondrosteosis Osteochondroma Congenital Turner s syndrome SHORT METACARPALS BIC PEN Basal Cell Nevus syndrome Idiopathic Chromosomal Turner s syndrome Pseudohypoparathyroidism/PseudoPseduohypoparathyroidism
12 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer Tumors DIAPHYSEAL LESIONS IN GENERAL CEMENT Cysts Enchondroma Metastasis Eosinophillic granuloma (EG) Non-ossifying fibroma (NOF) TB/infections CORTICAL LESION MOFOS Metastasis Osteomyelitis Fibrosarcom Osteoid osteoma Stress fracture
13 Chapter 01_1_32_F 2/20/06 2:32 PM Page 13 Chapter 1 / Musculoskeletal Radiology 13 ILIAC WING LESIONS Fibrous dysplaisa Unicameral bone cyst Chondrosarcoma Mets/Myeloma/Plasmacytoma Ewings VERTEBRA PLANA IMELT Infection Mets/Myeloma EG Lymphoma/Leukemia Trauma BONY SEQUESTRUM LIFE Lymphoma Infection Fibrosarcoma EG RIB LESION FAME Fibrous dysplasia ABC Metastatic/Myeloma/Lymphoma EG/Enchondroma
14 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer EPIPHYSEAL LESIONS CIGS Chondroblastoma Infection Giant cell tumor/granuloma (EG) Subchondral cyst FOCAL SCLEROTIC LESION HOME LIFE Healed NOF Osteoma Metastasis Ewing s sarcoma Lymphoma Infection/Infarct Fibrous dysplasia Enchondroma PERMEATIVE LESIONS FIRE Fibrosarcoma (Desmoid/MFH) Infection Round cell tumors EG Mets/Myeloma
15 Chapter 01_1_32_F 2/20/06 2:32 PM Page 15 Chapter 1 / Musculoskeletal Radiology 15 SKULL LESION MEL TORME Metastasis EG Lymphoma TB Osteomyelitis Radiation Mets Epidermoid TIBIAL LESION FOAM Fibrous dysplasia Osteofibrous dysplasia Adamantinoma Metastasis POSTERIOR VERTEBRAL BODY LESION GO TAPE Giant cell tumor Osteoblastoma TB ABC Paget disease EG
16 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer CALCANEAL LESION BIG G Bone cyst-unicameral Intraosseous lipoma Ganglion Giant cell tumor FINGER TIP LESION GEMS Glomus tumor Epidermoid/Enchondroma Metastasis (lung almost exclusively) Sarcoid SOFT TISSUE CALCIFICATION/OSSIFICATION My GHOSTS Myositis ossificans Gout Hyperparathyroidism Ochronosis Scleroderma/connective tissue disease Tumoral calcinosis Sarcoma (synovial cell)
17 Chapter 01_1_32_F 2/20/06 2:32 PM Page 17 Chapter 1 / Musculoskeletal Radiology 17 SACRAL LESION CAN Chondrosarcoma/Chordoma ABC/GCT Neurofibromatosis And always Mets/Myeloma/Lymphoma FLUID-FLUID LEVEL HOT MASS HemangiOma Telangiectatic osteosarcoma Metastasis ABC/GCT Synovial cell Sarcoma
18 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer Arthritis INFLAMMATORY ARTHRITIS 1. RF+ Rheumatoid Arthritis Symmetric SLE Subluxation/nonerosive Scleroderma DIP, PIP erosions Soft tissue Ca 2+ Acroosteolysis Dermatomyositis Soft tissue Ca 2+
19 Chapter 01_1_32_F 2/20/06 2:32 PM Page 19 Chapter 1 / Musculoskeletal Radiology RF Ankylosing Spondylitis SI joint involvement Reiters Foot > Hand Bony Proliferation Psoriasis Erosive Bony proliferation Asymmetric Sausage digit Ivory phalanx Pencil in cup Inflammatory Bowel Disease (IBD) Arthritis with IBD
20 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer 3. EROSIVE OA Dip Joints
21 Chapter 01_1_32_F 2/20/06 2:32 PM Page 21 Chapter 1 / Musculoskeletal Radiology 21 CRYSTAL ARTHRITIS 1. DEPOSTION Gout Marginal erosions Overhanging edges Preserved joint space
22 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer CPPD ChondroCa 2+ Cysts 2nd and 3rd MCP SLAC TFCCa 2+
23 Chapter 01_1_32_F 2/20/06 2:32 PM Page 23 Chapter 1 / Musculoskeletal Radiology OTHER Hemochromatosis Acromegaly Other Ochronosis Disc calcification Multicentric reticular histiocytosis Symmetric No osteopenia Infection Crosses Joint Space
24 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer OH MY GOD LESIONS VERY BIZARRE LOOKING GENERALIZED LESIONS THAT YOU HAVE NO IDEA WHAT IT IS, THINK OF: Paget disease Fibrous dysplasia Neurofibromatosis Charcot joints
25 Chapter 01_1_32_F 2/20/06 2:32 PM Page 25 Chapter 1 / Musculoskeletal Radiology 25 Metabolic OSTEOPENIA GENERALIZED Senile osteoporosis Osteomalacia Endocrine abnormalities Cushings (too much) Hypogonadism (too little) Anemia/Myelofibrosis/Gauchers Bone marrow Congenital Osteogenesis imperfecta Hyperparathyroidism
26 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer FOCAL Reflex sympathetic dystrophy (complex regional pain syndrome) Disuse Transient osteoporosis Migratory osteoporosis
27 Chapter 01_1_32_F 2/20/06 2:32 PM Page 27 Chapter 1 / Musculoskeletal Radiology 27 SPINE CALCIFICATION OF THE ANNULUS FIBROSIS Ankylosing spondylitis Disks unremarkable Ochronosis Disks calcified Abn SI joints OSTEOPHYTES DISH Disks unremarkable Normal SI joints
28 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer SYNDESMOPHYTES Psoriasis Reiters MARGINAL OSTEOPHYTES Spondylosis or degenerative OSTEOPHYTOSIS
29 Chapter 01_1_32_F 2/20/06 2:32 PM Page 29 Chapter 1 / Musculoskeletal Radiology 29 ARTHRITIS BASICS AND ARTHRITIS BY LOCATION ABCDS Alignment Bone Cartilage/calcifications Distribution Soft tissues Wrist 1st CMC, TFC CPPD Radiocarpal joint osteoarthritis CMC gout (marginal erosions) Hand DIP + PIP Osteoarthritis Osteophytes No erosions Erosive osteoarthritis Osteophytes Erosions Females Psoriasis/Reiters No osteophytes Erosions MCP + PIP Rheumatoid Erosions No osteophytes Osteopenia Psoriasis/Reiters Erosion Bony proliferation MCP Inflammatory Erosions CPPD/hemochromatosis Osteophytes Foot MTP JOINTS Hip RA Gout OA Neuropathic MIDDLE/HINDFOOT RA Osteoarthritis BONY PROLIFERATION OA Superolateral migration Ankylosing spondylitis Axial migration SI joint involvement symmetric Psoriasis/Reiters Axial migration SI joint involvement asymmetric CPPD Chondrocalcinosis NO. PROLIFERATION RA Acetabular protrusio Osteopenia
30 Chapter 01_1_32_F 2/20/06 2:32 PM Page Radiology: The Oral Boards Primer Knee COMPLETE JOINT INVOLVEMENT RA No bony proliferation Osteopenia Cyst formation JRA/hemophilia Wide femoral notch High density effusion Psoriasis/Reiter s Asymmetric Bony proliferation MEDIAL INVOLVEMENT Osteoarthritis PATELLOFEMORAL INVOLVEMENT CPPD Shoulder GLENOHUMERAL JOINT CPPD vs osteoarthritis not a weight-bearing joint ACROMIOCLAVICULAR JOINT Rotator cuff tear Glenohumeral joint spared TOTAL JOINT INVOLVEMENT Rheumatoid Symmetric NORMAL JOINT SPACE Hydroxyapatite crystal deposition disease
31 Chapter 01_1_32_F 2/20/06 2:32 PM Page 31 Chapter 1 / Musculoskeletal Radiology 31 NAMES TO KNOW UPPER EXTREMITY Mallet Finger Bennett s Rolando Gamekeeper Boxer s Colle s Smith s Chauffer s (Hutchinson s) Barton s Rev. Barton s Nightstick Monteggia Galleazzi Hill Sach s Bankart LOWER EXTREMITY Jones Lisfranc Choparts Maisonneuve Tillaux Wagstaffe-Lefort SPINE Jefferson Hangman Clay Shovelers Lefort I Lefort II Lefort III LOCATION OF INJURY Dorsal Base DP 1st MC base, intraarticular Communited 1st PP ulnar 5th MC Distal radius Reverse colles Radial styloid Dorsal rim Anterior rim Ulnar shaft isolated Ulna and radial + dislocation (elbow) Ulna and radial + dislocation (wrist) Humeral head Glenoid LOCATION OF INJURY 5th MT base 2-5 MT Talonavicular and calcaneocuboid dislocation Pronation external rotation injuryproximal fibula Anterior tibial tubercle Fibular avulsion LOCATION OF INJURY C1 lateral masses C2 pars Fx Posterior elements Through maxilla Nasal inferior orbital rims Nasal orbits
32 Chapter 01_1_32_F 2/20/06 2:32 PM Page 32
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