RAD 311 Radiographic Pathology Lecture Notes PDF

RAD 311 Radiographic Pathology Reham Garout [email protected] Marketing Department Mon. Feb. 21. 2018 Lecture 3 Musculoskeletal system Inflammatory Disease (1) Osteomyelitis (2) Arthritis Inflammatory diseases (1) Osteomyelitis:...

RAD 311 Radiographic Pathology Reham Garout [email protected] Marketing Department Mon. Feb. 21. 2018 Lecture 3 Musculoskeletal system Inflammatory Disease (1) Osteomyelitis (2) Arthritis Inflammatory diseases (1) Osteomyelitis: Infection of bone and bone marrow caused by pathogenic micro organism. spread via bloodstream.  Conventional x-ray: no specific changes can be demonstrated in a very early stage of infection as is not very sensitive but may demonstrate soft tissue swelling.  NM bone scan and MRI are more sensitive.  It requires prolonged antibiotic therapy for weeks or months. Inflammatory diseases Osteomyelitis: (advanced case)  Bone destruction of proximal and terminal phalanges of great toe with destruction of the cortex characteristic of osteomyelitis (white arrows).  There is also a pathologic fracture through the proximal phalanx (yellow arrow) Bone scan: increased uptake in MRI T1, extensive calcaneal osteomyelitis. both feet soft tissue ulceration and cellulitis. Inflammatory diseases (2) Arthritis: Arthritis is inflammation of joint. Two main types: (a) degenerative, in which pathologic changes begin in the articular cartilage of the joints. (e.g. osteoarthritis) (b) inflammatory, in which pathologic changes begin in synovial cartilage. It’s caused by an exaggerated immune response that attacks the joints. (e.g. rheumatoid arthritis, Ankylosing Spondylitis & gout) Inflammatory diseases Osteoarthritis: is a disease of cartilage, patients are generally asymptomatic until they are in their fifties.  Osteoarthritis is classified as; ❖ Primary Osteoarthritis; occurs as result of normal wear and tear of aging. ❖ Secondary osteoarthritis; occurs as result of bone stress associated with trauma, congenital anomalies or other disease. ❖ It affect the large weight-bearing joints e.g. hip &knee. ❖ Radiographs demonstrate narrowing of joint space, and osteophytes (bone spurs). Inflammatory diseases  complete loss of joint space in all the compartments of the knee with osteophyte formation. Inflammatory diseases Rheumatoid Arthritis (RA); chronic autoimmune disease.  Radiographic changes seen early in this disease soft tissue swelling and osteoporosis of the affected bones.  As disease progresses, cortical erosion with joint space narrowing occurs because of the overgrowth of synovial tissue into the articular spaces. Eventually, the joint became stiff and fused with alteration in the shape of the joint  Advanced rheumatoid arthritis Loss of intercarpal, carpometacarpal and distal radio-ulnar joint spaces ulnar deviation of MCP joints Inflammatory diseases Ankylosing Spondylitis:  Is a form of arthritis, mainly involving the spine, in joint and articulations become ankylosed, especially the sacroilliac joints.  Radiographs demonstrate bilateral narrowing and fuzziness of sacroilliac joints.  Later radiographic changes show calcification of the vertebral ligaments. The articular cartilage is destroyed and fibrous adhesions develop. End in bone fusion and calcification. Finally, spine become rigid block of bone (bamboo spine). Inflammatory diseases Gout type of inflammatory arthritis caused by uric acid crystals that form in and around the joints. occurring especially in men.  Commonly affect feet, ankle, hands, less commonly affect sacroiliac and shoulder joint.  Radiographic X-ray do not appear until after one year, in NM scan affected area shows increased radionuclide concentration.  Treatment by medication to promote or inhibit excretion of uric acid by kidneys Erosions with dense soft tissue swelling are seen at first MTP joints, right-sided first toe interphalangeal joint, PIP of right foot second and third toes. AP phalanges radiograph demonstrating bone erosion and soft tissue swelling Neoplastic Disease (1) Osteochondroma (2) Endochondroma (3) Simple bone cyst (4) Osteoid Osteoma & Osteoblastoma (5) Metastasis from other sites Neoplastic Disease (1) Osteochondroma (Exostosis); The most common benign bone tumor. Overgrowth of bone arises from the growth zone between the epiphysis and diaphysis (growth plate) of long bones. Osteochondroma on the Affects men more often medial aspect of distal femur arises from the growth zone between epiphysis & diaphysis Neoplastic Disease (2) Endchondroma; Is a slow growing benign tumor composed of cartilage, grow in marrow space and small bones of the hands & feet in patients between the ages 30 - 50 Do not invade surround tissue, But they expand cortical bone, causing thinning. Radiograph demonstrate radiolucent Endchondroma on the 5th metacarpal bone showing lesions containing small, stippled radiolucent lesions calcification, bubbly containing small, stippled calcification, Neoplastic Disease (3) Simple bone cyst: wall of fibrous tissue filled with fluid. Occur in long bone of children, Cause pain & pathological fracture. Radiograph demonstrate radiolucent well-defined margins from the normal bone surrounding the lesion. Small cyst tend to heal, larger one need surgical excision. Neoplastic Disease (4) Osteoid Osteoma & Osteoblastoma;  Common benign tumors of skeletal with similar histological features. They differ in size, origin and symptoms.  CT is the method of choice for both Osteoid osteoma Osteoblastoma Less than 2 cm larger Involve femur, tibia or Involve spine spine Painful Pain may not be present Lucent tumer, round Mixed lytic, oval Radiofrequency ablation Surgery Osteoid osteoma Humeral osteoid osteoma with no calcifications Osteoblastoma cervical spine CT scan obtained without contrast showing an expansive lesion with a multitude of small calcifications. Neoplastic Disease (5) Metastasis from other sites  The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called “secondary tumors”.  Radiographically, signs of bone mets. include change of bone density and architecture.  To be visible radiographically, the lesions must be greater than 1 cm in diameter with lost of 30% -50% of bone density. Neoplastic Disease Bone scan- "hot" lesion in the right femoral head although there is minor linear activity in the L4 Neoplastic Disease Bone scan may indicate mets. that cannot be confirmed by plain film. CT is used to clear up discrepancies MRI may also be employed to differentiate between tumor tissue and normal bone marrow. The most common primary sites for mets. bone cancer are the breast, lung, prostate, kidney, thyroid and bowel. Treatment of mets. Depends on primary disease, but radiation therapy, chemotherapy or hormone therapy is commonly used to manage such patients. Metabolic Disease (1) Osteoporosis (2) Osteomalacia (3) Paget’s disease Metabolic Disease (1) Osteoporosis :  abnormal decrease in bone density Although the formation of bone is normal, the bone reabsorption rate is abnormally high in individuals with osteoporosis  Osteoporosis results in thinning of the cortical bone and enlargement of the medullary canal with a change in actual diameter of bone.  X-ray radiographs can only identify a loss of bone mass when it is advanced (>30%-50%).  The best method for evaluating early stages of osteoporosis is the mineral densitometry of the hip and lumbar spine using DEXA T score Dual-Energy X-Ray Absorptiometry (DeXA) of Osteoporosis Metabolic Disease (2) Osteomalacia:  a condition caused by lack of calcium in the tissues and a failure of bone tissue to calcify. This normally results from inadequate intake or absorption of calcium, phosphorous, or vitamin D, most commonly as a consequence of intestinal malabsorption of fats  The bones are sponge-like, and demonstrate osteopenia on radiographic evaluation.  Radiographically, it appear similar to osteoporosis except of presence of band of radiolucency within the bone, term pseudofractures or looser’s zones  Bone biopsy is definitive method of determining the presence of osteomalacia. Multiple pseudofractures/Looser zones are seen Metabolic Disease (3)Paget’s Disease (Osteitis Deformans) metabolic disorder of unknown etiology that is in the elderly population, affecting men more than female.  Affect one or more bones, e.g. pelvis, spine, skull and long bones.  Softness of bone leads to weight- bearing, stress- induced deformities (bend) and fractures.  Skull enlarges, additional complications may occur, these include hearing and vision disturbances.  There is no known cure for this disease. Metabolic Disease  Radionuclide bone scans detect Paget’s disease even in early stages.  Radiographically , the affected bones demonstrate cortical thickening, thicken trabecular pattern.  Mixed areas of radiolucent osteoylsis and radiopaque intense uptake of several lower thoracic vertebrae, L3, right osteosclerosis may be seen hemipelvis, sacrum, left proximal (cotton wool appearance). femur and right knee. There is expansion and bowing of the femur.  1 The x-ray image demonstrate: Rheumatoid Arthritis Osteoarthritis Osteomyelitis  2  Which of the following is a Neoplasstic Disease Endchondroma Osteomalacia Osteomyelitis  3 Which of the following diseases has the pseudofractures or looser’s zones Paget's Osteomalacia Osteoblastoma Thank You