general msk laurie lomasney, md professor department of radiology
TRANSCRIPT
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General MSK
Laurie Lomasney, MDProfessor
Department of Radiology
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General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
• Locale– Axial– Appendicular
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General MSK by Disease Category
• Disease processes often follow predictable patterns of radiographic change
• Disease processes usually follow particular distribution patterns
• Pretest probability enhances image interpretation and directed reporting
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General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
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Arthropathy
• Characteristics– Bone density– Erosions– Alignment
• Distribution– Poly vs mono– Symmetric vs asymmetric– Peripheral small vs central large
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Arthropathy
Periartic demin
Prox/Symmetric swelling
Wrist/MCP erosions
Palmar/Ulnar deviat
Rheumatoid Arthritis
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Arthropathy
Preserved density
Asymmetric swelling
Prox + Distal asymm erosions
Psoriasis
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Arthropathy Osteoarthritis
Variable density
No erosions
Eccentric joint narrow
Marginal proliferation
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Arthropathy
Preserved density
Debris
Sclerosis
MalalignmentCharcot Arthropathy
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General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
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Infection
• Characteristics– Periarticular demineralization– Bone erosion– Periosteal new bone– (Adjacent ST defect or Foreign body)
• Distribution– Focal/monostotic vs Multifocal
(uncommon)
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Infection
Metaphyseal osteomyelitis
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InfectionDIP Pyarthrosis
Hip Pyarthrosis
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General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
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Congenital
• Variable appearance• Variable consequence
– Incidental– Pathologic
• Always• Sometimes
– Unknown
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Congenital
• Ossification neural groove
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Congenital
Os Acromiale
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CongenitalOs tibiale externum
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Congenital
= 80%
Narrow Bony Canal
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General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
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Vascular (Avascular necrosis)
• Multiple etiologies– Steroid therapy– Collagen vascular disease– Post-traumatic
• Staged appearance– Sclerosis– Collapse– Secondary osteoarthritis
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Avascular necrosis
Lunate AVN
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Avascular necrosis
Femoral head AVN
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General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
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Tumor
• Etiologies – Multiple• Distribution – Specific to process
– Axial vs appendicular– Monostotic vs polyostotic– Medullary vs eccentric– Child vs Adult
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Tumor
• Characteristics to observe– Well-defined vs permeative– Cortical destruction– Periosteal new bone– Internal matrix– Soft tissue mineralization/mass
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TumorNon-ossifying fibroma
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Tumor
Giant cell tumor
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TumorEnchondroma
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Tumor
Chondrosarcoma
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TumorOsteogenic sarcoma
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Tumor
Osteosarcoma
Gross pathology
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General MSK
• Radiology is a four-year residency• Pathology generally follows a
predictable imaging pattern• Knowledge of patterns can
enhance image interpretation
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You know you’re in medicine when:• You compliment strangers on the size of
their veins. • You occasionally have to leave a
patient's room before you start laughing uncontrollably..
• You have recurring nightmares about being knocked to the floor and run over by a portable x-ray machine.
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Thank you
Laurie Lomasney, MD