general msk laurie lomasney, md professor department of radiology
TRANSCRIPT
General MSK
Laurie Lomasney, MDProfessor
Department of Radiology
General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
• Locale– Axial– Appendicular
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
General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
Arthropathy
• Characteristics– Bone density– Erosions– Alignment
• Distribution– Poly vs mono– Symmetric vs asymmetric– Peripheral small vs central large
Arthropathy
Periartic demin
Prox/Symmetric swelling
Wrist/MCP erosions
Palmar/Ulnar deviat
Rheumatoid Arthritis
Arthropathy
Preserved density
Asymmetric swelling
Prox + Distal asymm erosions
Psoriasis
Arthropathy Osteoarthritis
Variable density
No erosions
Eccentric joint narrow
Marginal proliferation
Arthropathy
Preserved density
Debris
Sclerosis
MalalignmentCharcot Arthropathy
General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
Infection
• Characteristics– Periarticular demineralization– Bone erosion– Periosteal new bone– (Adjacent ST defect or Foreign body)
• Distribution– Focal/monostotic vs Multifocal
(uncommon)
Infection
Metaphyseal osteomyelitis
InfectionDIP Pyarthrosis
Hip Pyarthrosis
General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
Congenital
• Variable appearance• Variable consequence
– Incidental– Pathologic
• Always• Sometimes
– Unknown
Congenital
• Ossification neural groove
Congenital
Os Acromiale
CongenitalOs tibiale externum
Congenital
= 80%
Narrow Bony Canal
General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
Vascular (Avascular necrosis)
• Multiple etiologies– Steroid therapy– Collagen vascular disease– Post-traumatic
• Staged appearance– Sclerosis– Collapse– Secondary osteoarthritis
Avascular necrosis
Lunate AVN
Avascular necrosis
Femoral head AVN
General MSK
• Disease Categories– Arthropathy– Infection– Congenital– Vascular– Tumor
Tumor
• Etiologies – Multiple• Distribution – Specific to process
– Axial vs appendicular– Monostotic vs polyostotic– Medullary vs eccentric– Child vs Adult
Tumor
• Characteristics to observe– Well-defined vs permeative– Cortical destruction– Periosteal new bone– Internal matrix– Soft tissue mineralization/mass
TumorNon-ossifying fibroma
Tumor
Giant cell tumor
TumorEnchondroma
Tumor
Chondrosarcoma
TumorOsteogenic sarcoma
Tumor
Osteosarcoma
Gross pathology
General MSK
• Radiology is a four-year residency• Pathology generally follows a
predictable imaging pattern• Knowledge of patterns can
enhance image interpretation
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.
Thank you
Laurie Lomasney, MD