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General MSK

General MSK. Laurie Lomasney, MD Professor 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

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General MSK

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  1. General MSK Laurie Lomasney, MD Professor Department of Radiology

  2. General MSK • Disease Categories • Arthropathy • Infection • Congenital • Vascular • Tumor • Locale • Axial • Appendicular

  3. 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

  4. General MSK • Disease Categories • Arthropathy • Infection • Congenital • Vascular • Tumor

  5. Arthropathy • Characteristics • Bone density • Erosions • Alignment • Distribution • Poly vs mono • Symmetric vs asymmetric • Peripheral small vs central large

  6. Arthropathy Rheumatoid Arthritis Periartic demin Prox/Symmetric swelling Wrist/MCP erosions Palmar/Ulnar deviat

  7. Arthropathy Psoriasis Preserved density Asymmetric swelling Prox + Distal asymm erosions

  8. Arthropathy Osteoarthritis Variable density No erosions Eccentric joint narrow Marginal proliferation

  9. Arthropathy Preserved density Debris Sclerosis Malalignment Charcot Arthropathy

  10. General MSK • Disease Categories • Arthropathy • Infection • Congenital • Vascular • Tumor

  11. Infection • Characteristics • Periarticular demineralization • Bone erosion • Periosteal new bone • (Adjacent ST defect or Foreign body) • Distribution • Focal/monostotic vs Multifocal (uncommon)

  12. Infection Metaphyseal osteomyelitis

  13. Infection DIP Pyarthrosis Hip Pyarthrosis

  14. General MSK • Disease Categories • Arthropathy • Infection • Congenital • Vascular • Tumor

  15. Congenital • Variable appearance • Variable consequence • Incidental • Pathologic • Always • Sometimes • Unknown

  16. Congenital • Ossification neural groove

  17. Congenital Os Acromiale

  18. Congenital Os tibiale externum

  19. Congenital = 80% Narrow Bony Canal

  20. General MSK • Disease Categories • Arthropathy • Infection • Congenital • Vascular • Tumor

  21. Vascular (Avascular necrosis) • Multiple etiologies • Steroid therapy • Collagen vascular disease • Post-traumatic • Staged appearance • Sclerosis • Collapse • Secondary osteoarthritis

  22. Avascular necrosis Lunate AVN

  23. Avascular necrosis Femoral head AVN

  24. General MSK • Disease Categories • Arthropathy • Infection • Congenital • Vascular • Tumor

  25. Tumor • Etiologies – Multiple • Distribution – Specific to process • Axial vs appendicular • Monostotic vs polyostotic • Medullary vs eccentric • Child vs Adult

  26. Tumor • Characteristics to observe • Well-defined vs permeative • Cortical destruction • Periosteal new bone • Internal matrix • Soft tissue mineralization/mass

  27. Tumor Non-ossifying fibroma

  28. Tumor Giant cell tumor

  29. Tumor Enchondroma

  30. Tumor Chondrosarcoma

  31. Tumor Osteogenic sarcoma

  32. Tumor Osteosarcoma Gross pathology

  33. General MSK • Radiology is a four-year residency • Pathology generally follows a predictable imaging pattern • Knowledge of patterns can enhance image interpretation

  34. 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.

  35. Thank you Laurie Lomasney, MD

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