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Aneurysmal Bone Cyst Findings:

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Presentation on theme: "Aneurysmal Bone Cyst Findings:"— Presentation transcript:

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2 Aneurysmal Bone Cyst Findings:
expansile lytic lesion of the distal ulnar metaphysis well-defined margins internal septations No periostitis A result of trauma or tumor induced process ddx: Giant cell tumor Chondroblastoma Osteoblastoma Fibrous Dysplasia lytic met

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4 Osteopetrosis (Marble bones, Albers- Schoenberg)
Findings: generalized increased bone density rare bone dysplasia Trabecular --> compact Anemia w/extramedullary hematopoiesis ddx: (children) pyknodysostosis renal osteodystrophy vit A, D Lead Fluorosis

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6 Paget’s Disease Findings:
Enlargement of the right femoral head with course and thickend trabecula Asymmetric lucency of the right superior acetabulum ddx: NONE! This is an Aunt Minnie!

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10 Brown Tumor Findings: expansile, lytic rib lesion
lytic lesion of 2nd PP subperiosteal bone resorption arterial Ca2+ Usually secondary to CRF but may be primary check for PT adenoma if on dialysis, check wrist for amyloid arthropathy (cysts in carpal bones) ddx: metastases multiple myeloma

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13 Bucket-Handle Tear Findings:
“double PCL sign” - torn meniscus BELOW normal PCL on sag view Above ACL on cor view Truncation of medial meniscus Joint effusion Medial = 3x lateral Locked knee ddx: torn ACL, PCL torn meniscus

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15 Ankylosing Spondylitis
Findings: fused SI joints right hip erosions lumbar syndesmophytes Sero-negative chronic inflammatory disease Starts in the low back and progesses upward ddx (sacroilitis) bilateral ank spond IBD Unilateral Reiter’s psoriasis

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18 Femoral Head AVN Findings: bilateral femoral head AVN w/o collapse
right pelvic renal tx

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21 Hill-Sachs Deformity and Osseous Bankart Lesion
Findings: Impaction fracture of the posterolateral humeral margin (Hill-Sachs) Fracture of the osseous glenoid rim (Bankart) secondary osteoarthritis Related to repeated anterior dislocations (shoulder instability) Bankart lesion is typically only of the cartilaginous labrum, best seen on MRI

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24 Lateral Patellar Dislocation
Findings: bone bruise of lateral femoral condyle and medial patella injury of the patellar retinaculum joint effusion Patella usually dislocates lateral (medial facet more acute angle) Look for constellation of findings

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26 Metastatic Renal Cell Findings:
expansile lytic lesion of the distal ulnar metaphysis well-defined margins internal septations No periostitis Don’t forget about mets! ddx: ABC Giant cell tumor Chondroblastoma Osteoblastoma Fibrous Dysplasia

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28 Homolateral Lisfranc farcture/dislocation
Findings lateral subluxation of the second through fifth metatarsals dislocation is relative to the cuneiforms: homolateral divergent (1st MT medial) can be due to trauma or in patients with diabetic neuropathy

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30 Osteochondritis Dissecans
Findings: defect in the medial talar dome representing an osteochondral fracture Unknown etiology but most common causes are: trauma osteonecrosis Do MRI w/ or w/o arthro to look for free fragment

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32 Pellegrini-Stieda disease
Findings: Linear ossific density adjacent to the medial femoral condyle Calcification or ossification of the MCL at its insertion site Sequela of previous injury NOT acute, usually not the site of pain

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35 Bilateral SCFE Findings:
posteromedial displacement of femoral epiphyses Most common cause of limp in adolescents SH-I shearing fx high incidence in black, overweight pubertal males 75% uni, 25% bi Look for line along lateral femoral neck to transect 1/6th of epiphysis Must be pinned or fixed

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38 Synovial Sarcoma Findings: Dense soft tissue mass no bony involvement
heterogeneous T1 Rare soft tissue tumor of children May show calcification Internal hemorrhage and necrosis are common Found close to joints Prone to metastases ddx: (plain film only) hematoma

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40 Unicameral Bone Cyst Findings:
lytic, slightly expansile lesion of the proximal metaphysis with a thin sclerotic margin and fracture a.k.a. simple bone cyst fluid-filled cavity common lesion of children, unknown etiology asymptomatic unless fracture (“fallen fragment sign”)

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42 Melorheostosis Findings:
Peripheral hyperostosis of the tibia producing a wavy sclerotic diaphyseal contour Rare bone disorder of childhood “candle wax” dripping down the bone appearance presents with PAIN and joint swelling ddx: Paget’s myelofibrosis renal osteodystrophy sclerotic mets

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44 Congenital Reubella w/patent ductus arteriosis
Findings: cardiomegaly, enlarged pulm arteries longitudinal striations of sclerotic and radiolucent areas at the metaphyses (“celery stalk” appearance) epiphyseal center not seen dense, irregular metaphyseal bands most common viral infxn w/bone changes (also CMV) IUGR, TTP, cataracts, sensorineural hearing loss, PDA, pulm art and Ao stenoses

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47 Aneurysmal bone cyst Findings:
Lucent end of bone lesion in the proximal tibia Slightly expansile, mild periosteal reaction Fluid-fluid level on MRI ddx: Giant cell tumor Unicameral bone cyst Fibrous dysplasia Chondroblastoma (rare)

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49 Inferior shoulder dislocation
Findings: Inferior dislocation of humeral head and a deep cleft in the superior portion ddx: Anterior dislocation

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51 Dens metastasis C1-2 subluxation
Findings: 8mm anterior subluxation of C1 on C2 with flexion Conventional tomogram shows C2/dens lytic lesion and pathologic fracture ddx: Rheumatoid Dens fracture

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53 C3 vertebra plana (multiple myeloma)
Findings: Complete compression of C3 (look at the vertebral bodies and their corresponding posterior elements!) ddx: Metastasis Kommel’s disease (if see gas and collapse) EG

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55 Calcaneal stress fracture
Findings: Patchy linear and arc-like sclerosis in the posterior calcaneous ddx: NONE! This is an Aunt Minnie!

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57 Enchondroma Findings:
Patchy sclerotic intramedullay lesion in the proximal tibial metadiaphysis “Rings and arcs” calcification ddx: Enchondroma with chondrosarcomatous degeneration Bone infarct

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59 Cleidocranial dysplasia
Findings: Absent central portion of clavicle with rudimentary medial and lateral portions Congenital coxa vara Widened appearance of pubis (due to delayed ossification) ddx: NONE! This is an Aunt Minnie!

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61 Cystercercosis Findings:
Innumerable round and oval soft tissue calcifications ddx: Diffuse dystrophic or metastatic calcifications

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63 Giant cell tumor Findings:
Expansile lucent lesion in the fibular head containing multiple thin septa ddx: Aneurysmal bone cyst Fibrous dysplasia Lytic metastasis Brown tumor Chondroblastoma (rare)

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65 Hypertrophic Osteoarthritis
Findings: Diffuse symmetrical periosteal reaction of the distal radius, ulna, and tibia ddx: Adults Pulmonary Pachydermoperiostitis Vascular insufficiency Thyroid acropachy Fluorosis Peds Caffey disease Leukemia Rickets Hypervitaminosis A

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67 Hyperparathyroidism Findings: “salt and pepper” skull
Osteopenia with course trabecula Subperiosteal resorption ddx: NONE! This is an Aunt Minnie!

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69 Tumoral Calcinosis Findings:
Multiple dense calcifications around the joints of the fingers and wrists ddx: (soft tissue Ca2+) Renal osteodystrophy Heterotopic ossification Metastatic Ca2+ Milk-alkali syndrome Hypervitaminosis D Scleroderma Dermatomyositis

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71 Lymphoma Findings: Permeative lytic lesion of the humeral diaphysis
Periosteal reaction and soft tissue swelling ddx: Osteomyelitis Metastasis Ewing’s Sarcoma EG

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73 Osteomalacia w/ Looser’s zone
Findings: Osteopenia Horizontal linear lucency in the medial femoral metaphysis Causes: Renal osteodystrophy Hyperparathyroidism Vit D deficiency ddx: NONE! This is an Aunt Minnie!

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75 Knee fracture Findings: Lipohemarthrosis
No visible fracture but one is definitely present ddx: NONE! This is an Aunt Minnie!

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77 Osteochondromatosis Findings:
Flared metaphyses due to multiple bony outgrowths = exostoses Contiguous with cortex and medulla Point away from joint Look for pain (after bony maturation) – check cartilagenous cap = >2cm, risk of chondrosarcoma ddx: NONE! This is an Aunt Minnie!

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79 Paget’s Disease w/ sarcomatous degeneration
Findings: Cortical thickening with mixed lytic and sclerotic trabecular pattern and bony enlargement Large lytic lesion of the right ilium and sacral ala ddx: Diffuse sclerotic and lytic mets

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81 Rickets Findings: Cupped and frayed metaphyses
Wide physes (increased osteoid) Long bone bowing Decreased bone density ddx: NONE! This is an Aunt Minnie!

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83 Bilateral perched lumbar facets
Findings: Mild anterolisthesis of L4 on L5 Inferior L4 facets perched on superior L5 facets ddx: NONE! This is an Aunt Minnie!

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85 Rheumatoid arthritis Findings:
Destruction of the dens and the anterior C1 arch by a soft tissue mass Impression of the anterior thecal sac with slight deformation of the cervical cord ddx: Infection Metastasis

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87 Septic Arthritis Findings:
Lytic and sclerotic destruction of the great toe MTP joint Joint space narrowing Periosteal reaction Soft tissue swelling ddx: Charcot joint Metastasis with pathologic fractures

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90 Potts Disease Findings:
Complete collapse of L4 and cauda equina compression Subligamentous soft tissue extension to L3 body ddx: Staph aurius Gram negatives (IVDA)

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92 Enchondroma Findings:
Lucent, slightly expansile lesion of the fifth MC ddx: Giant cell tumor UBC Fibrous dysplasia

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94 Discitis Findings: T12-L1 disc space narrowing with endplate destruction CT demonstrates presence of gas ddx: NONE! This is an Aunt Minnie!

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96 Right hip synovitis Findings:
Asymmetric teardrop distance (greater on right) Normal joint space ddx: Infection Rheumatoid

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98 Osteogenesis Imperfecta Type II
Findings: multiple fractures, bowing and short ribbon-like bones Type II - lethal - “ribbon bones” and fractures too numerous to count Disturbances in type I collagen lack of normal collagen osteoperosis fractures blue sclera ddx: NONE! This is an Aunt Minnie!

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100 Polyostotic fibrous dysplasia
Findings: Multiple lucent and expansile lesions “ground glass matrix” May be seen on precocious puberty – McCune Albright syndrom ddx: Multiple enchondromas

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102 Renal osteodystrophy Findings: Osteopenia Prominent trabecular pattern
“rugger jersey” spine ddx: NONE! This is an Aunt Minnie!

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104 Eosinophilic Granuloma
Findings: Well-defined lytic lesion in the frontal skull crossing the diploic space Overlying scalp swelling Positive bone scan ddx: Osteomyelitis Metastasis

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106 Prostate metastases Findings: Diffuse sclerosis ddx: Breat, GI mets
myelofibrosis renal osteodystrophy osteopetrosis multiple myeloma

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108 Surpacondylar Process of the Humerus
Findings: large osseous projection originating from mid humerus and extending inferiorly into the arm Normal anatomic variant May cause median nerve compression ddx: NONE! This is an Aunt Minnie!


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