EXPERTddx : Musculoskeletal by B. J. Manaster MD PhD FACR, Catherine C. Roberts MD, Carol

By B. J. Manaster MD PhD FACR, Catherine C. Roberts MD, Carol L. Andrews MD, Cheryl A. Petersilge MD

A part of the EXPERTddx sequence, this specified print-and-electronic reference will consultant radiologists towards logical, on-target differential diagnoses in keeping with key imaging findings and scientific details. The ebook provides the main valuable differential diagnoses for the musculoskeletal process, grouped into 3 different types: anatomy established, picture established (radiograph/CT, MR, ultrasound, nuclear medicine), and clinically dependent. each one differential prognosis comprises at the very least 8 transparent, sharp, succinctly annotated photos; an inventory of diagnostic probabilities taken care of as universal, much less universal, and infrequent yet vital; and short, bulleted textual content supplying useful diagnostic clues.The spouse on-line Amirsys ebook virtue presents extra annotated pictures.

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This was painful & showed cortical breakthrough on MR; it proved 10 be a renal cell metastasis. •. III o 3 '< [l:J III III Giant Cell Tumor Tendon Sheath (Left) AP ,adiograph shows a Iylic well-circumscribed lesion" in a 45 year old woman. There was no other finding of knee arlhropathy. However, there were classic findings of gout involving Ihe 1st MTP; sodium urale crystals were seen on knee aspirate. It MSK Req). (Right) Lateral radiograph shows lytic lesions involving Ihe epiphysis & head of adjacent phalanges" Volar sofl tissue mass helps make Ihe diagnosis of GCT tendon sheath, which may erode underlying bone.

This is a form of chronic Salter f injury that is seen particularly in young gymnasts. FRAYING • Osteomyelitis, Pediatric o Focal metaphyseal osteopenia & destruction • Physeal Fractures, Pediatric o Any healing fracture or avulsion • Child Abuse, Metaphyseal Fracture o Corner fractures, cupping late Helpful Clues for less Common Diagnoses • Rickets o Metaphyseal osteolysis & cupping, coarse ill-defined trabecula, rachitic rosary, enlarged knees, ankles, & wrists o Generalized osteopenia, delayed skeletal maturation, bowing • Thermal Injury o Soft tissues changes including calcification • Neuropathic Disease o Exaggerated changes including extensive fragmentation Helpful Clues for Rare Diagnoses • Radiation o Regional osteopenia • Hypophosphatasia o Hint: Distinct finger-like lucent extension into metaphysis from growth plate o Osteopenia, cranial synostosis, bowing, fractures, metaphyseal spurs • Copper Deficiency, Infantile o Metaphyseal cupping & spurs, hypotonia, seizures, mental retardation • Metaphyseal Chondrodysplasia o Metaphyseal cupping, short stature, bowing Chronic Repetitive Trauma Coronal oblique Tl WI MR shows widening and irregularity of the physis _ in this Little League pitcher with chronic injury from throwing curve balls.

The patient is 38 years old; despite the young age, metastasis must be strongly considered. • May be geographic, with sclerotic margin • May be highly permeative, eliciting periosteal reaction, cortical breakthrough, and soft tissue mass Helpful Clues for Less Common Diagnoses • Giant Cell Tumor, Aggressive o GCT arises in the metaphysis, extending towards the subchondral bone o GCT generally is eccentric within the metaphysis, but as it grows to occupy the entire metaphysis it may appear central o Most GCT cases are geographic • Narrow zone of transition, but non-sclerotic margin o GCT may occasionally develop a more aggressive appearance and behavior, with rare malignant behavior • Angiosarcoma, Osseous o Discussion includes other aggressive vascular lesions (hemangioendothelioma, hemangiopericytoma) o Located preferentially in lower extremities (including pelvis) o Lesions in long bones tend to be located centrally in metaphysis o May be solitary, but often polyostotic o Range of aggressiveness from geographic to highly permeative • Chronic Recurrent Multifocal Osteomyelitis o Long term pain, but X-rays often normal o Metaphyseal & axial lesions seen optimally on MR, appearing aggressive & multifocal o 3 '< [Jl III VI CD C- o o :J (Q OJ o :J (t) s:: (t) 0; "0 ::T '< VI (t) OJ Metastases, Bone Marrow PA bone scan in the same patient shows the expected lesion ~ & demonstrates it to be solitary.

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