bone diseases
description
Transcript of bone diseases
![Page 1: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/1.jpg)
bone diseases
Lecture no. 3
Prepared by Dr.Salah Mohammad FatihMBChB,DMRD,FIBMS(radiology)
![Page 2: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/2.jpg)
![Page 3: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/3.jpg)
Multiple focal lesions
![Page 4: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/4.jpg)
Metastases & multiple myeloma are most common cause of obvious multiple lytic lesions in the bone.
![Page 5: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/5.jpg)
metastases Is the commonest malignant bone tumor. Those bones contains red marrow are the commonest
site to be affected, namely spine, skull, ribs, pelvis, humeri & femora.
![Page 6: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/6.jpg)
Types of metastases Lytic secondary deposit;
Sclerotic metastases;
Mixed lytic & sclerotic secondary deposits;
![Page 7: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/7.jpg)
Sclerotic bone metastases • Most commonly arises from prostate cancer, but also arise from breast,
lung and carcinoid
![Page 8: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/8.jpg)
CT: Osteolytic lesions
Most commonly arises from breast, lung, thyroid, renal, melanoma, and gastrointestinal malignancies
![Page 9: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/9.jpg)
CT: Mixed lesions / mixture of osteoblastic and osteolytic lesions / seen in breast cancer
![Page 10: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/10.jpg)
Lytic secondary deposit; in the adult most commonly from , breast & bronchus &
less commonly from carcinoma of the thyroid, renal, colon in the children from neuroblastoma.
Radiologically appear as a well-defined or ill-defined areas of bone destruction without sclerotic rim.
Sclerotic metastases; in the men most commonly from prostate & in the
female from Ca breast, it appear as ill-defined areas of increased density of varying sizes with ill-defined margin.
Mixed lytic & sclerotic secondary deposits; they are most commonly from Ca breast
![Page 11: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/11.jpg)
Notes; bone expansion uncommon in metastases except in Ca
thyroid & kidney.
periosteal reaction is uncommon with metastases except in neuroroblastoma.
Isotope scan is much more sensitive than plain film in detecting bone metastases & if multiple areas of increased activity are seen in a patient with known primary Ca, then the Dx of metastases is virtually certain .
![Page 12: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/12.jpg)
MRI is better than isotope scan for detecting & it shows more metastases but is more difficult to survey the whole skeleton with MRI.
CT less sensitive than MRI for detecting metastases, but can demonstrate lytic & sclerotic metastases & the image should be reviewed on bone windows .
![Page 13: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/13.jpg)
Multiple myeloma They are more commonly seen in active
heamopoetic areas . It is resemble lytic metastases but it is
often better defined. Diffuse marrow involvement may cause
generalized loss of bone density producing a picture similar to that of osteoporosis.
Most meyloma deposite show increased activity on isotope scan
![Page 14: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/14.jpg)
![Page 15: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/15.jpg)
Generalize decreased bone density(osteopenia)
![Page 16: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/16.jpg)
1. Osteoporosis.2. Osteomalacia.3. Hyperparathyroidism.4. Multiple myeloma.
Main causes of generalized decrease in bone density;
![Page 17: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/17.jpg)
Radiographic density of the bone depend on the amount of calcium present in the bone.
decrease in bone calcium lead to decrease in bone density.
![Page 18: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/18.jpg)
Osteoporosis is the consequence of a deficiency of protein matrix(osteoid) & decrease amount of the normal bone (i.e. loss of bone mass) while remaining bone is normally mineralized (microstructure of the bone remain normal & histologically also normal)
osteoporosis
![Page 19: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/19.jpg)
Osteoporosis predispose to fractures , specially vertebral bodies & hips.
![Page 20: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/20.jpg)
1-Idiopathic; according to the age, subdivided to; Juvenile Senile Postmenopausal; up to 50% of female over 60
years of age have osteoporosis. 2-Cushing’s disease & steroid therapy.
3-disuse
Main Causes of osteoporosis
![Page 21: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/21.jpg)
Change in bone density usually unapparent until 30-50% of the bone mass has been lost.
Decreased cortical thickness.
Decreased no. of the trabeculae present in the bone.
Radiological features
![Page 22: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/22.jpg)
Empty box
Prminent vertical trabicuale
VB compression fracture
Generalized decrease in bone density
![Page 23: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/23.jpg)
Changes best seen in the spine. Resorption of the horizontal trabeculae. Empty box ; apparent increased end plate
density due to Resorption of the spongy bone.
VB compression fracture; wedged or biconcave types with apparent widening of the disc spaces
![Page 24: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/24.jpg)
Local decreased bone density caused by localized pain or immobilization of a fracture
Disuse osteoporosis
![Page 25: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/25.jpg)
Indistinctness of the cortex of the right femoral head and osteopenia of the entire femoral head
![Page 26: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/26.jpg)
There is poor mineralization of osteoid.
If occur before epiphyseal closure, it known as rickets.
If occur in adult ,it known as osteomalacia.
Rickets & osteomalacia
![Page 27: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/27.jpg)
This patient shows abnormal bone density, with coarsened abnormal trabeculae in a generalized pattern. Even more prominently, we see widened and irregular metaphyses
Rickets
![Page 28: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/28.jpg)
The anterior ends of the ribs are quite abnormal in this patient, with splaying at the costochondral junction
Rickets (rachitic rosary)
![Page 29: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/29.jpg)
The changes are maximal where bone growth is occur, so they best seen in the knees, wrists & ankles
1. Loss of provisional zone of calcification.2. Indistinct metaphyses & metaphyses become irregular and
cupped.3. Wide growth plate.4. decreased bone density.5. Deformities of the bones occur because of bone softening.6. Greenstick fractures are common
Radiological finding of rickets
![Page 30: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/30.jpg)
This patient has generalized osteopenia. In addition, several of the right lower ribs demonstrate transverse fractures with a wide lucency at the fracture site (arrow). Your diagnosis?
Osteomalacia with looser’s zone
![Page 31: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/31.jpg)
Radiological findings;
1. Decreased bone density.
2. Looser’s zones; are short lucent band running through the cortex at the Rt angles & may have sclerotic margin, commonest site are scapula, medial aspect of femurs,& pubic rami & ribs
3. Bone deformity due to bone softening e.g. biconcave vertebra bodies
osteomalacia
![Page 32: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/32.jpg)
Cause mobilization of the calcium from the bone, resulting in a decreased bone density.
Hyperparathyroidism could be primary hyperparathyroidism (90 percent due to an adenoma) or secondary hyperparathyroidism due to renal dysfunction.
Hyperparathyroidism
![Page 33: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/33.jpg)
Many patients with primary hyperparathyroidism present with renal stone & minority present with radiologically detected bone changes.
![Page 34: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/34.jpg)
Radiological features of hyperparathyroidism
![Page 35: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/35.jpg)
Extensive subperiosteal resorption is seen on both the radial and ulnar side of the middle phalanges (white arrows, left hand). brown tumor in the left distal ulna as well as the left trapezoid (black arrows, left hand).a as well as in the right head of the third metacarpal and the base of the proximal phalanx of the fifth digit (black arrows, right hand).
![Page 36: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/36.jpg)
Features of both primary & secondary hyperparathyroidism are similar except that brown tumors are much rarer & vascular calcification is commoner in secondary hyperparathyroidism
![Page 37: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/37.jpg)
vascular calcification is the predominant finding
Hyperparathyroidism from renal osteodystrophy.
![Page 38: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/38.jpg)
1. Generalized decrease in bone density.
2. The hallmark of hyperparathyroidism is subperiosteal bone Resorption.
3. Soft tissue calcification; vascular & chondrocalcification sometime occur.
4. Brown tumor are occasionally present which are small lytic lesion which could be single or multiple
hyperparathyroidism
![Page 39: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/39.jpg)
Generalized increase in bone density
![Page 40: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/40.jpg)
Causes;1. Sclerotic metastases, commonest cause.
2. Osteopetrosis (marble bone disease); congenital, bone sclerotic & brittle leading to multiple fractures.
3. Myelosclerosis;there is replacement of the bone marrow by fibrous tissue & lay down of the bone which is usually appear as patchy areas of sclerosis
![Page 41: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/41.jpg)
This child has extremely dense bones throughout the body. There is abnormal modeling at the metaphyses with flaring. Your diagnosis?
Osteopetrosis
![Page 42: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/42.jpg)
Alteration in trabecular pattern & changes in the shape
1. Paget’s disease2. hemolytic anemia
![Page 43: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/43.jpg)
Usually is the chance finding in elderly. One or more bones may be affected, the
usual sites are pelvis, spine , skull & long bones
1-Paget’s disease
![Page 44: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/44.jpg)
this patient gives a classic appearance of advanced mixed lytic and sclerotic Paget's disease , bone expansion,loss of corticomedullary differentiation and anterior bowing of the tibia
Paget’s disease
![Page 45: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/45.jpg)
typical picture-frame appearance of VB due to the enlargement and mixed lytic sclerotic pattern.
Paget's dsease
![Page 46: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/46.jpg)
Cardinal features are ; thickening of the trabeculae & the cortex,
causing increase in bone density & loss of corticomedullary differentiation.
Enlargement of the affected bone.
Bone softening causes bowing & deformity of the bones & pathological fracture may occur
Radiological finding of Paget’s disaese;
![Page 47: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/47.jpg)
There are many types of hemolytic anemia , but radiological changes are seen in main two types; thalassaemia & sickle cell disease.
Both causes bone marrow hyperplasia, but sickle cell disease also may show evidence of bone infarction & infection
2-Hemolytic anemia
![Page 48: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/48.jpg)
dense striations in a very widened diploic space of the cranium (hair-on-end appearance). Additionally, note that the paranasal sinuses are obliterated
Thalassemia
![Page 49: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/49.jpg)
The metacarpals and phalanges are squared and show a very thinned endosteal cortex with abnormal density. Resorption of some trabeculae & remaining trabeculae become thick & prominent.
Thalassemia
![Page 50: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/50.jpg)
Thinning of the cortex & bone expansion.
Resorption of some trabeculae & remaining trabeculae become thick & prominent.
In the skull; it cause widening of the deploe & perpendicular striation occur which is known as ‘ Hair-on-end’.
The ribs may enlarged & phalanges may become rectangular.
Radiological features of marrow hyperplasia
![Page 51: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/51.jpg)
JOINTS
Prepared by Dr.Salah Mohammad FatihMBChB,DMRD,FIBMS(radiology)
![Page 52: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/52.jpg)
Imaging technique Plain film remains important for imaging
the joint, but MRI is being increasingly used & specially useful for;
Meniscal & ligamentous tear in the knee. Rotator cuff tear of the shoulder. Avascular necrosis in the hip joint. Septic arthritis
![Page 53: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/53.jpg)
Arthrography; involve injection of the contrast media in to the joint space .
MR arthrography has role in the shoulder & wrist joints.
![Page 54: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/54.jpg)
Plain film signs indicating presence of arthritis
1-Joint space narrowing.
2-Soft tissue swelling.
3-Osteoporosis.
![Page 55: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/55.jpg)
1-Joint space narrowing; It occur in all forms of joint diseases
except avascular necrosis.
![Page 56: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/56.jpg)
2-Soft tissue swelling; Periarticular soft tissue swelling is a feature
of inflammatory & infective arthritis.
Discrete asymmetrical periarticular soft tissue swelling can be seen in gout due to gouty tophi
![Page 57: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/57.jpg)
3-Osteoporosis;
Occur in many type of painful conditions & underuse of the bones is an important cause.
![Page 58: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/58.jpg)
Diagnosis of arthritis
![Page 59: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/59.jpg)
To Dx arthritis, it is important to have the following information;
1- Is more than one joint involved? RA, typically involve several joint while
infection & synovial tumors usually involve single joint.
![Page 60: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/60.jpg)
2-Which joints are involved?
RA virtually involve the hand & feet, principally MCP, PIP, wrist joint &MTP.
Psoriatic arthritis usually affect the DIP.
Gout typically involve MTP of the big toe.
OA when seen in the hands ,it almost always involves DIP& often affect the CM joint of the thumb & in the large joints, it commonly involve hip& knee, but relatively rare in the ankle , shoulders & elbow joints unless there is some underlying causes.
Neuropathic arthritis ; Diabetic affect ankles & feet while syringomyelia affect shoulders, elbows & hands
![Page 61: bone diseases](https://reader033.fdocuments.in/reader033/viewer/2022051422/56816562550346895dd7e8e0/html5/thumbnails/61.jpg)
3-Is a known disease present ? e.g hemophilia, DM