3. UNC MSK Course Day 6 Lab XR UNKNOWNS (for self study)

4. Pathology?

5. Mixed sclerotic and lucent areas in both femoral heads

6. Pathology? Mixed sclerotic and lucent areas in both femoral heads AVN hips

7. Pathology?

8. Increased trabeculation Cortical bone shows strongly due to loss of cancellous bone, Vertebral compression fracture.

9. Pathology? Increased trabeculation Cortical bone shows strongly due to loss of cancellous bone, Vertebral compression fracture. Osteoporosis - differential would include osteomalacia, could also be osteoporosis with pathologic compression fracture secondary to cancer (metastatic or myeloma most likely).

10. Pathology?

11. Sclerosis of the navicular in a patient with open physes

12. Pathology? Sclerosis of the navicular in a patient with open physes Kohler’s disease (AVN navicular) More obvious case in younger child normal

13. Pathology?

14. Bowing of femur. Pseudofracture (Looser’s line”)

15. Pathology? Bowing of femur. Pseudofracture (Looser’s line”) Osteomalacia

16. Pathology?

17. Sclerotic and lytic areas with collapse of capital femoral epiphysis R hip

18. Pathology? Sclerotic and lytic areas with collapse of capital femoral epiphysis R hip Legg Perthes disease (AVN)

19. Pathology?

20. Sclerosis lateral dome of talus. Post fracture

21. Pathology? Sclerosis lateral dome of talus. Lucency/osteoporosis of medial dome indicating stress protection and resorption of calcium (and therefore intact blood supply) is called a “Hawkin’s sign”. Post traumatic AVN medial part of talar dome

22. Pathology?

23. Multiple lytic lesions with surrounding sclerosis

24. Pathology? Biopsy shows numerous giant cells

25. Pathology? Biopsy shows numerous giant cells Serum calcium is high

26. Pathology? Biopsy shows numerous giant cells Serum calcium is high Brown’s tumors of hyperparathyroidism

27. Pathology? If you were thinking multiple myeloma because of the multiple lesions, remember it starts centrally and only shows up in the limbs late in the disease when the patient is devastated. Also the sclerotic rim would be unlikely. If you were thinking Giant Cell Tumor, remember they occur in the epiphyses and are usually singular.

28. Pathology?

29. Displaced femoral neck fracture Increased trabeculation

30. Pathology? Displaced femoral neck fracture Increased trabeculation (large trabeculae are more visible as small ones disappear. Osteoporosis – differential would include osteomalacia.

31. Pathology?

32. Wide “cupped” physes Bowed legs

33. Pathology? Wide “cupped” physes Bowed legs Nutritional Rickets

34. Vitamin D Resistant Rickets (May be difficult to differentiate from other causes of bowing on basis of X-ray alone.) (Sex linked dominant trait)

35. Ketchican, Alaska