1. Musckuloskeletal MCQs

2. Aneurysmal Bone Cyst (ABC)
Definition
expansile lesion of bone containing thin-walled blood- filled cystic cavities
Etiology
(a) primary nonneoplastic lesion (2/3)
(b) arising in preexisting bone tumor (1/3): giant cell tumor (39%),osteoblastoma, chondroblastoma,solitary bone cyst,fibrous dysplasia,nonossifying fibroma, metastatic carcinoma
Histology
intraosseous arteriovenous malformation" with honey- combed spaces filled with blood + lined by granulation tissue / osteoid; areas of free hemorrhage

4. Aneurysmal Bone Cyst (ABC)
Types:
INTRAOSSEOUS ABC : originating in bone marrow cavity.
EXTRAOSSEOUS ABC :posttraumatic hemorrhagic cyst; originating on surface of bones
Age:
peak age 16 years (range years)
Location:
Spine: with slight predilection for posterior elements
long bones: eccentric in metaphysis of femur, tibia, humerus, fibula; pelvis

5. Respect epiphyseal plate
soap-bubble
Thin internal trabeculations
Almost invesible cortex
Expansile lesion
No periosteal reaction except in case of fracture

12. Doughnut sign in scintigraphy

13. Aneurysmal Bone cyst : Occur secondary to fibrous dysplasia
Can present with scoliosis
May contain fluid-fluid level at MRI
Contain calcified matrix
Doughnut sign at scintigraphy is pathognomonic
(√ )
(√ )
(√ )
(X )
(X )

14. Multiple Myeloma

15. Mulyiple osteolytic Punched-out lesion

16. Mulyiple osteolytic Punched-out lesion
Absence of perilesional sclerosis

17. Complicated by pathological fracture
Associated with osteopenia

18. PET PET-CT coronal view

19. (√ ) also following radiotherapy
Regarding Multiple Myeloma :
It is the commonest 1ry neoplasm of bone
Generalised osteopenia is a recognised appearance
Scintigraphy over-estimates disaese extent
Lesions becomes scleotic following chemotherapy
Vertebral pedicle destruction is an early event
(√ )
(√ ) in 15 %
(X ) under estimates
(√ ) also following radiotherapy
(X )
(Ref: Grainger and Allison pp ,Daenhartppp , Chapman 2003pp )

20. Rheumatoid arthritis :

21. Joint deformity
Periarticular osteopenia
Narrowing of the joint spaces
Soft tissue swelling
Joint instability due to ligament rupture
Articular erosion

22. High ridding of the humerus
Lateral erosion of the clavicle
Marginal erosion
Narrowing of the glenohumoral joint

23. Lateral deviation of toes , Hammer toes
Erosion of the MTP

24. ligamentous destruction can result in atlantoaxial impaction
Erosion of Odontoid process
Pannus proliferation directly compresses the spinal cord.
Erosion of facet joints

25. (X ) Hyperparathyroidism
Erosion of the lateral 3rd of the clavicle is seen in the following:
Rheumatoid arthritis
Ankylosing spondylitis
Langerhans cell histiocytosis
Hypoparathyroidism
Multiple myeloma
(√ )
(X )
(X )
(X ) Hyperparathyroidism
(√ )

26. Concerning Malignant Bone Lesions

27. (X ) 90% in basisphenoid and sacrum
Concerning Malignant bone lesion:
Chordoma is most common in the thoracolumbar spine
Fibrosarcoma is the commonest tumour 2ry to paget’s disease
Adamantinoma occursin the tibia in over 90% of cases
Angiosarcoma has a soap bubble appearance at radiography
Chondroblastoma are typically found in the diaphysis
(X ) 90% in basisphenoid and sacrum

28. Sacral Chordoma

29. Basisphenoid Chordoma

30. (X ) 90% in basisphenoid and sacrum
Concerning Malignant bone lesion:
Chordoma os most common in the thoracolumbar spine
Fibrosarcoma is the commonest tumour 2ry to paget’s disease
Adamantinoma occurs in the tibia in over 90% of cases
Angiosarcoma has a soap bubble appearance at radiography
Chondroblastoma are typically found in the diaphysis
(X ) 90% in basisphenoid and sacrum
(√ )
(√ )

31. Adamantinoma

32. (X ) 90% in basisphenoid and sacrum (X ) they are epiphyseal lesions
Concerning Malignant bone lesion:
Chordoma os most common in the thoracolumbar spine
Fibrosarcoma is the commonest tumour 2ry to paget’s disease
Adamantinoma occursin the tibia in over 90% of cases
Angiosarcoma has a soap bubble appearance at radiography
Chondroblastoma are typically found in the diaphysis
(X ) 90% in basisphenoid and sacrum
(√ )
(√ )
(√)
(X ) they are epiphyseal lesions

34. Chondroblastoma

35. Thank you