BONE

WHAT IT COULD BE

The sign & findings

Wide zone of transition is being

Benign or malignant ????

Codman's triangle

Elevation of the periosteum at the side of the tumor margin

lytic, expansile lesion, Sub articular in location give the soap bubble appearance

Giant cell tumor

onion peal periosteal reaction

Characteristic of Ewings Sarcoma

Tumor have slender pedicle directed from growth plate ,,, what it could be ??? Is the direction of pedicle toward joint or away ????? What is being have at upper aspect ??? What is their significance ???

Pedunculated: slender pedicle directed away from growth plate . The thickness of the cartilage cap above the bony projection is very important if the thickness > 1 cm of cartilaginous cap by CT, > 2 cm by MRI give high possibility of Malignant transformation Also Dispersed calcifications in the cap *



(Ollier's disease) means multiple enchondromatosis Diaphyseal acalsia means multiple exostosis Multiple ivory osteoma associated with Gardner's syndrum


(* Rain drop appearance ( multiple lytic lesion in skull MM * Rackety rosary of the ribs mean widening of the anterior end of the rib seen in (rickets) * codfish appearance Vertebral collapse resulting in biconcave vertebra with widened disc (osteomalasia ) *Triradiate pelvis in which pelvic side walls bend inward (sever cases of osteomalasia ) * Looser's zones these are thin short lucent lines with sclerotic margins running across the cortex at right angle, best seen in the scapula , femoral neck , pubic rami (osteomalacia )


*Legg-Calve-Perthes disease osteochodrosis of the femur head *Mushroom deformity of femoral Neck (perthes diseade ) *Scheuermann's disease : (adolecent Kyphosis) osteochodrosis of the vertebral end plates *Osgood-Schlatter osteochodrosis of the tibial tubercle *Blount's disease tibial epiphysis *Kohler's Navicular bone *Kienbock's lunate bone *Osteochondritis dissecans separation of the affected part in to the joint space resulting in intra-articular loose body seen in large joint * Psueodoarthrosis of the femoral head with iliac bone (old neglected CDH)

Bamboo spine … Ankylosing spondylits

Fallen fragment sign

shepherd crook deformity seen in fibrous dysplasia

The whole vertebral body marked by vertical striation … being Haemangioma

lucent area surrounded by calcification nidus surrounded by sclerotic rim with or without periosteal reaction


Both secondary metastasis & MM being cause multiple lytic lesion within the skeletal system who can you differentiated secondary from MM if each one of them affecting vertebra ???? * secondary M primarily affecting & have predilection to pedicle * MM spares vertebral pedicle.


causes of reduced bone density: Metastatic carcinoma. Multiple myeloma. Hyperparathyroidism. Osteomalacia. Osteoporosis .

Causes of generalized increase in the density of the bone

1.Sclerotic metastases. 2.Osteopetrosis (Marble bone disease) 3.renal osteodystrophy 4.Fluorosis 5.Myelosclerosis

Who can you do Von Rosen view

At 3-6 months : abduction of the thigh 45 degree and internal rotation

Define the following

Define

Acromegaly & prognathism

Wormian bone

Spondylolysis and spondylolisthesis

Spondylolisthesis is a term denoting fore ward or backward movement of a vertebra relative to the vertebral segment below, typically due to spondylolysis (pars interarticularis defects) .Spondylolysis - “Spondylolysis is a defect in the pars interarticularis of the neural arch, the portion of the neural arch that connects the superior and inferior articular facet in which cause defect in the neck of scotty dog .


sacroiliitis & facet joint ankylosis
Q..Being charct. Of which one of the following ???*Ankylosing spondylitis*DISH Ans…. Ankylosing spondylitis ( is the true answer ) Q..What do you mean the symbol ( DISH ) ???? Ans….DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS

*Erosive changes of DIP and PIP (osteoarthritis ) *Peri articuler erosive changes at 2nd and 3rd MCP joint( Rheumatoid arthritis ) *punched out peri articuler lytic lesion affecting 1st MTP joint (of the big toe ( Gout Sub periosteal resorption at the radial aspect of the middle phalanges (hyper parathyriodism )

Types of metastasis

Osteolytic (most common causes) : neuroblastoma (in children), breast (adult female), bronchus (adult male), thyroid, kidney, colon The vertebral pedicles are often involved. Osteoblastic : prostate, breast , carcinoid , TCC of bladder,, neuroblastoma. Mixed: breast, prostate, lymphoma. Solitary expansile bubbly metastases with soft tissue involvement: thyroid, kidney. Bone metastases with sun burst periosteal reactions: prostate, retinoblastoma and neuroblastoma

Very important note

Myeloma resembles metastases in everything except : *it's more well defined, *cause bone expansion if solitory called plasmacytoma *spares vertebral pedicle

Skull manifestation of the acromegaly

1.Thickening of the skull vault &diplioc space 2.Thickening of the posterior occipital tubercle 3.Prognathism 4.Froehead bossing with enlargement of the frontal sinuses also with enlargement of the mastiod air cell . 5.Balloning with Double floor appearance of the sella tursica .

Osteophytes, Subchondral sclerosis Uneven loss of articular space These signs being of which one of the following ??? 1.Metabolic arthritis 2.Degenerative arthritis 3.Inflammtory arthritis True answer is Degenerative arthritis

Q….What are the main 5 radiological sign of degenerative arthritis ?? ???Q….What sign in spine being pathgnomonic for degenerative spondylosis of the spine ???Vacuum phenomenon: gas (N2),is pathognomonic of the degenerative processQ…what are the types of inflammatory arthritis

Q… what are he early changes seen in Rheumatoid arthritis ??Q…CDH occurs most commonly in ???? (70%) in the left hip . Bilateral involvement is seen in 5%Q…By simple diagram draw pelvis with lines (shenton’s & Perkins line)


Very important notes
* Well defined clear cut with narrow zone of transition indicates benign or slowly growing lesion. * Ill-defined wide zone of transition indicates aggressive rapidly growing lesion as osteo myelitis and malignant tumors. * Metastases & myeloma lie in the middle of the spectrum (well defined lytic lesion with no sclerotic margin).

* commonest malignant tumors affecting the bone ??? secondary metastasis*the commonest primary malignant bone tumor in young adults ?? Osteosarcoma Q….lytic, expansile lesion, Sub articular in location, Not clearly defined margin with thinning of the cortex ???Giant cell tumor