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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Extra resources for EXPERTddx : Musculoskeletal
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.