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Diagnosis Modality Information Other ABC Clavicle / MR Expansile Lucent 2006 ORAL BOARD REVIEW: MSK Diagnosis Modality Information Other ABC Clavicle / Expansile lucent lesion in distal clavicle. ABC: 2/3 Isolated. 1/3 secondary to tumor: MR F/F level on MR. Pathological fracture (Telangectatic) Osteosarc, chondroblastoma, osteoblastoma, GCT. AC Joint Degeneration MR Air Filled AC joint and Geode. Acetabular Labral Tear MRI Czerny IIIA. ACL avulsion Knee/MR Avulsion of anterior tibial spine. Rec: MR for evaluation of ACL fibers. ACL Tear MRI Avulsion from intercondylar roof Associated Fxs: Tibial eminence avulsion, segond (Blumensaat's Line). Anterior drawer sign. (lateral), deep notch. Adventitial Bursitis MR Non-synovial adventitial bursa over an osteochondroma. Osteochondroma may be complicated by Fx, malignant degeneration, or neurovascular compromise. ALPSA CT Anterior Labral Periostial Sleeve Avulsion. See Graphic Anterior displacement of the laburm over the glenoid. Seen with a Hill-Sachs. Angiosarcoma Mets Film/MDP 38 year old with multiple MDP hot lucent lesions. DDx: MM (too young), EG (too old), Mets (lung, bladder, thyroid, renal), Infection (Cocci) Anklylosing Spondylitis Pelvis/MR High T2 signal in sacral and iliac aspects of Note: Symmetry of abnormality is a plain film bilateral SI joints, as well as pubic finding ONLY. This does not correlate with MRI. symphysis. Plain film shows SI jt space widening and Pubic symphisis irregularity. Anklylosing Spondylitis Spine SI joints involved first with bilateral, symmetric erosion -> sclerosis -> ankylosis. Spine disease later: Thoracolumbar predilicetion. Early osteitis = Squared vertebral bodies & Shiny Corner. Syndesmophyte formation -> Bamboo Spine = fusion and ligamentous ossification. Anterior Shoulder Shoulder Anterior and Inferior lesion (>90%). Disslocation Associated with Bankhart and Hill-Sachs Arthitis Mutlians Hands Most commonly associated with RA and Psoriasis. This case = mixed connective tissue disease with plaque-like soft tissue calcification, erosions, and subluxations. AVN Ankle Talar dome sclerosis proximal to talar neck AVN: Bilateral 40%. fracture fixation. Absent Hawkin's sign Double Line Sign: Internal hyperemia/granulation = T2 bright//Compact sclerotic bone = T2 dark. MSK 5/22/2007 2:52 PM 1 of 14 2006 ORAL BOARD REVIEW: MSK AVN Hip/MR Crescent sign. MR shows a double line Ficat Classification: Stage 1 = normal or slight sign = infarct. Double Line Sign - looks like change in density. Stage 2 = Mixed STRIPES - DDx: Steroids, Trauma, Renal osteopenia/sclerosis. Stage 3 = Subcondylar Failure, Idiopathic, Pancreatits, EtOh, collapse: Cresent Sign. Stage 4 = Articular Sickle Cell Dz. collapse. Stage 5 = Progression to DJD. Barnkhardt Shoulder / Also see hill-sachs MR Benign Fibro-Osseous Knee NOF, Bone Island (enostosis), and BFOL: NOF, Ossifying Fibroma, Fibrous Dysplasia, Lesions Osteochondroma. Osteofibrous Dysplasia, Liposclerosing myxofibrous tumor. Biceps Tear MR Edema and no visualized biceps tendon lateral to brachialis. Bucket Handle Meniscal Tear MRI Double PCL sign, truncation, medial displacement. Medial > Lateral. Butterfly Vertebrae Lspine Congenital Anomaly Calcaneal Bone Cyst Foot DDx: Lipoma (may have central calcification), pseudocyst, or neoplasia with secondary cyst formation. Calcaneonavicular coalition Foot Anteater sign = anterior process of the Subtalar coalition: Talar Beak, C-Sign, Talar dome calcaneus. Oblique view shows C-N rounding, lack of middle facet visualization. coalition. Fibrous connection present at birth, but painful later due to ossification. Calcific Tendinitis Knee / Patellar tendon high signal and thickening MR with knee effusion on MR. Plain film shows calcification in patellar attachment sight. Calcific Tendinitis Shoulder Amorphis calcification (not ossification) in subscapularis tendon. DDx: Tumoral calcinosis, loose body, avulsion fragment. Carpal Fusion Wrist Congenital or acquired Chance fracture Lspine Anterior compression with mid and posterior Seatbelt fracture through pedicles. flexion. Associated with abdominal (bowel) injury. Charcot joint Foot Fragmentation of multiple joints. Predilection for Lisfranc joints in the foot. Presence of gas in soft tissue indicates DM. Note: Neurogenic change can be very rapid (months). Chondroblastoma Knee Epiphyseal well circumscribed geographic DDx: GCT in skeletally mature patient. CIGGG lesion with chondroid matrix. Usually in skeletally immature patient Chondroblastoma MRI Enhancing masslike T2 bright lesion in T2 bright with enhancement is non-specific: greater trochanter (epiphyseal equivalent). infection, tumor, mass. Adjacent soft tissue enhancement indicates aggressive. Bx to show Chondroblastoma. DDx: Infection, GCT, Met, Primary. Chondroblastoma (Atypical) Pelvis/CT Expansile lesion at triradiate cartilage. CT Atypical location for chondroblastoma. shows chondroid matrix = chondroid tumor. DDx: mets, myeloma, infection. MSK 5/22/2007 2:52 PM 2 of 14 2006 ORAL BOARD REVIEW: MSK Chondroblastoma (Typical) All Typical locations = ends of long bones and Secondary ABCs are common. posterior spinal elements. Chondromixoid Fibroma CT/MR Lucent lesion with soft tissue mass. (CMF) DDx=osteoblastoma, encondroma, NOF, FD, UBC/UBC. Chondrosarcoma MR Chondroid matrix (Lobular High T2 = Flat Bones - think mets. Arcs/Rings) soft tissue mass adjacent to cortex = cortical break = aggressive tumor. DDx: Chondroid tumor (chondrosarcoma or other), atypical osteosarcoma, Mets (especially in flat bones), Myeloma. Chondrosarcoma - Femur Encondroma with endosteal scalloping. On Degeneration from NM MDP scan, chondrosarcoma shows Encondroma marked uptake, while encondroma shows mild to moderate. Chondrosarcoma in MHE MRI Aggressive lesion breaking through cortex Flat bone dx: Mets, myeloma, lymphoma of ilium into soft tissue. DDx: Mets, myeloma, lymphoma, primary. Chondroid matrix: lobular, T2 bright atypical for mets, myeloma, lymphoma. Femoral Osteochondroma nails the diagnosis. Chronic osteomyelitis Clavicle/C Monostotic mixed, but primarily sclerotic T lesionwith thick periosteal reaction. Long abnormality. DDx = infection or malignancy (lymphoma, mets), SAPHO (if involves joint space or with skin changes) Chronic osteomyelitis Femur Ehrlenmyer's flask with coursened Ehrlenmyer's Flask: Gauchers, Nieman-Pick, sclerotic/lucent lesion. Anemia, FD, Osteopetrosis, Pyles, Heavy Metal Poisioning. Clay Shoveler's Fracture Cspine May occur with flexion or extension injury. Clavicular Post-Traumatic Clavicle Distal clavicle resorption in a young healthy Distal Clavicular Resorption: RA, HPTH, Osteolysis patient (weight lifter). Traumatic osteolysis, Infection, Cleidocranialdysostosis, Mets, Myeloma. Compression Fracture Lspine Endplate sclerosis. Second to insufficiency from Steroids. MRI to exclude underlying mass. Cortical Desmoid Knee Posteromedial femoral metaphysis. @ adductor Magnus insertion. CPPD Knee Cartilagenous calcification. Fibrous CPPD: hook-shaped osteophytes. DDx: calcification is non-specific. Hyaline hemochromatosis calcification: CPPD, HPTH, Hemochromatosis. Cyclops Lesion MR Granulation tissue after ACL repair. Intermediate signal similar to hyaline cartilage. Can be difficult to see. MSK 5/22/2007 2:52 PM 3 of 14 2006 ORAL BOARD REVIEW: MSK Cystic Angiomatosis Hand Erosions away from joints with dense phleboiths of the soft tissues Diabetic Muscle Infarction MRI Focal muscle T2 bright enhancing muscle. Myositis (trauma, infection, inflammatory). Focal area of sparing = non-affected muscle groups. Discoid meniscus with tear MRI Lateral meniscus more prone to discoid variant, predisposing to tear. DISI Wrist Dorsal Intercalated Segment Instability: VISI: Palmarly flexed lunate relative to the distal Carpal Instability with dorsal flexion of the row. Scapholunate angle <30. Associated with lunate relative to the dorsal row. Associated Luno-Triquetral Ligament disruption. with Scapholunate ligament disruption (Terry Thomas Sign) and Scapholunate Angle >60 (normal = 30-60) Diskitis/Osteomyelitis Lspine Destruction/sclerosis on opposite sides of disk. EG Skull / Skull lucency and Vertebral Plana Lytic lesion of orbit with soft tissue mass. Spine EG with secondary ABC CTLS/CT Anterior elements = EG, GCT, Infection. Secondary ABCs may occur and mask pathology. Posterior elements=ABC, osteoblastoma. Enchondroma Femur / Fluid signal with lobulation/micronodularity, Phalangeal Enchondroma does not need MR indicating cartilage. calcification, but do fracture. DDx: Mets: Lung Cancer Mets can go distally. Elastofibroma MRI Benign lesion deep to latissimus dorsi. Middle aged older women. ? Mechanical etiology. Bilateral in 30%. Enchondroma with Malignant Tib Endosteal Scalloping, Periosteal Reaction Degeneration and pain. Evaluate with CT/MR Erosive OA Hand Gullwing erosions and joint space narrowing Erosive OA treated in some cases with in OA distribution: DIP, PIP, sparing MCPs. methotrexate. Fibrous Dysplasia CT Developmental anomaly - replacement of Polyostotic with Endocrinopathy = McCune Albright. the medullary cavity with fibrous material, With ST Myxomas = Maza Braud Syndrome. woven bone, and spindle cells. Age 5-20 Rare Sarcomatous Degeneration years. Monostotic form: Femur most common. Polyostotic Form: Femur, Tibia, Pelvis [often unilateral]. Radiographically: Radiolucent and expansile with GG matrix (dysplastic microtrabecullae). Well defined sclerotic margins. Base of skull lesions tend to be sclerotic. Mimics other lesions: may have atypical appearances. Long lesion in a long bone . Crosses joint space (pelvis -> femur).
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