The Skeletal System Chapter 2
Imaging Consideration Diagnostic images include soft tissue and bony structure of interest. Soft tissue areas often hold clues to the diagnosis. Any signs of muscle wasting, soft tissue swelling, calcifications, opaque foreign bodies, or the presence of gas may indicate disease.
MRI Magnetic Resonance Imaging Provides soft tissue detail because of its superior contrast resolution. Exams: staging of soft tissue tumors of the extremities, joints, bone marrow imaging… just to name a few
CT Computed Tomography Better contrast resolution than radiography. Exams: trauma, extend of fractures, dislocation, joint abnormalities, excellent ability to display bony margins and trabecular patterns.
NM Nuclear Medicine Demonstrates metabolic function Exam: bone scan Allows the metabolic function of the entire skeletal system to be evaluated at one time. Demonstrates the metabolic processes of the bone caused by disease processes.
DEXA Bone Mineral Densitometry Double-energy x-ray absorbtiometry Evaluate the bone density by evaluating the bone mass of the distal radius, femoral neck, and lumbar spine
Congenital and Hereditary Diseases
Osteogenesis Imperfecta
Osteogenesis Imperfecta
Achondroplasia Most common inherited disorder affecting the skeletal system Results in deformity and dwarfism Cartilage in the epiphyses does not convert to bone normally
Congenital Achondroplasia
Achondroplasia
Osteopetrosis Increased exposure factors are required Some cases, adequate penetration may never be achieved
Infant Osteopetrosis
Malformations
Syndactyly
Polydactyly
Clubfoot (talipes)
Congenital hip dislocation
Congenital scoliosis Fig. 2-14 AP lumbar spine radiograph demonstrating congenital scoliosis.
Scoliosis & Rotoscoliosis
bilateral lumbar ribs Fig. 2-15 AP lumbar spine radiograph demonstrating bilateral lumbar ribs.
spina bifida occulta Fig. 2-16 Abdominal radiograph of a patient with spina bifida occulta of the lower lumbar vertebrae.
Fig. 10-22 A normal neural arch in comparison to congenital defects: A, Normal. B, Spina bifida occulta. The median segment of the vertebral arch is missing and covered by skin. C, Meningocele. The arch is mostly absent with a bulging dura; however, the spinal cord remains in the vertebral canal. D, Myelomeningocele with a deformed spinal cord within the protruding dural sac. E, Myelocele: the area is totally exposed.
fetus with anencephaly Fig. 2-18 Abdominal radiograph of a pregnant woman carrying a fetus with anencephaly. Notice the lack of the cerebral cranial bones.
Inflammatory Disease
Chronic osteomyelitis Fig. 2-19A Chronic osteomyelitis demonstrated in a knee with prior fusion. An involucrum surrounded by fluid densities is seen in the middle of a large intramedullary cavity approximately 3 cm above the fusion site.
rheumatoid arthritis “swan sign”
rheumatoid arthritis Fig. 2-22A PA hand image demonstrating advanced rheumatoid arthritis with subluxation of the first metacarpophylangeal joint.
R.A. Fig. 2-22B Lateral hand image demonstrating advanced rheumatoid arthritis with subluxation of the first metacarpophylangeal joint.
Arthritis –joint inflammation
Arthritis
Cystic Arthritis
Arthritic Dislocation - Patella
ankylosing spondylitis Fig. 2-24B Lateral lumbar spine radiograph on a 64-year-old man with ankylosing spondylitis. Notice the fusion of the vertebrae into a solid block of bone.
Ankylosing Spondylitis
osteoarthritis Fig. 2-25 AP and oblique ankle radiographs demonstrating osteoarthritis.
chronic bursitis calcium deposits Fig. 2-29 Shoulder radiograph demonstrating radiopaque calcium deposits within the bursa caused by chronic bursitis.
gout Fig. 2-30A PA foot radiograph demonstrating bony erosion of the tarsal bones from gout.
gout Fig. 2-30B Lateral foot radiograph demonstrating bony erosion of the tarsal bones from gout.
Metabolic Disease
osteopenia steroid use Fig. 2-31A AP lumbar spine radiograph demonstrating osteopenia secondary to long-term steroid use.
osteopenia A radiographically visible decrease in bone density Bone loss must be at least 30% to radiographically demonstrate Fig. 2-31B Lateral lumbar spine radiograph demonstrating osteopenia secondary to long-term steroid use.
Ostopenia
Rickets or Osteomalacia
Paget’s disease Fig. 2-33 Lateral skull radiograph depicting an advanced proliferative phase of Paget’s disease. Notice the changes within the inner and outer tables of the skull.
Paget’s disease
Paget’s disease
Arachnodactilia from Acromegaly
Marfans Syndrome
Bone Spur
spondylolisthesis Fig. 2-39 L5-S1 spot radiograph of a woman complaining of low back pain, demonstrating spondylolisthesis of this joint.
spondylolisthesis
spondylolisthesis
Neoplastic Disease
Bone Cyst
Bone Cyst
simple bone cyst FX ? Fig. 2-45 AP radiograph demonstrating a well-circumscribed radiolucency consistent with a simple bone cyst.
Ostocondroma
Ostocondroma
Osteosarcoma
metastatic disease Fig. 2-52 AP hip radiograph demonstrating metastatic disease from a primary breast cancer.
Dislocation
Dislocation
Dislocation of the Patella
osteosarcoma Fig. 2-48B Follow-up MRI of the knee reveals an osteosarcoma that has replaced the distal femoral condyle.
osteosarcoma
Trauma & other stuff
Dislocation
Dislocation
Dislocation
Fat Pad Sign
Fracture?
Diabetic Changes
Avascular Necrosis
Avascular Necrosis
Free air from puncture wound
Calcified Bakers Cyst
Calcified Bakers Cyst
Syphilis