Communicating Bad NewsJump to first page
Bone & soft tissue lesions
Fracture/ patologic fracture
The origin of the lesion dan the type of the tumor ( benign/malignant)
Guiding biopsy
Follow Up
X-ray
MRI
Skintigraphy
USG
Angiography
Although modality progress in radiology is very fast, The convetional radiology is still very important
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A.metaphyseal & a. epiphyseal (direct suplay for meta/epiphyse)
A. Periosteal (branch from nutricia artery which through the Harvers & Volkman system)
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Development anomaly/Congenital
Upper extremities :
Phacomelya proximal
Robert = Nagle bilateral
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Congenital Coxa vara kongenital: bowing femur, bilateral shortening
Patella bipartite & multipartite
Leg & ankle :
- Hemivertebra
- Sacralisation
- Lumbalisation
- Scoliosis
- External contamination
- metaphyseal (distal femur, proximal tibia , proximal dan distal humerus ,radius, ulna and collumna vertebrae )
Radiology :
Lytic lesion can occur
Marginal type
column, disc damage very fast
narrowing disc
- destruction of disc slowly
- if extend to the periphery the process is same with marginal
C. Anterior type
- process under periosteum
- Disc destruction slowly
Severe ; sublucsation, dislocation with fracture
External : accident, fall
Internal : strong and sudden muscle contraction, for example : epilepsi, tetanus & electric shock
b. Fracture
soft tissue damage
Post reposition
1-2 weeks to follow up the position of the bone fracture(changing position or no)
6-8 minggu callus formation
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Severe deformity
Avultion fr.
a.Colles Fracture
Distal radius fr. (until 1 mm ) with posterior angulation, posterior dislocation & deviation of distal fragmen to radial.
b. Smith Fracture
Distal radius fr. with dislocation of fragmen distal to volar.
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b. Galeazzi fr.
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March fr. metacarpal
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A. Rickets (Hypovitaminosis D)
Bone disease deficiency vit D with kidney and mineral absorbtion disorder
Roentgenographic feature :
3. Bowing long bone
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4. Commonly Greenstick fr.
8. skull : Fontanella + suture (still open)
9. Osteoporostic
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B. Scurvy (hypovitaminosis C)
Caused of deficiency Vit C make the failure of intracellular forming include bone,catilage & endotel forming
The bone forming is persued but the reabsorbtion still happen osteoporosis
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7. Subperiosteal hematoma calcification
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A.Fibrous dysplasia
divided into 2 : monostatic (femur, tibia, costae,& facial bone) dan Polystatic (many bone unilateral)
Rontgen :
Sometimes sclerotic is dominant
Skull : marginal sclerotic, wide diploe, uppermost of tabula external (tabula internal not frequent), sclerotic of skull base, sphenoid crypt & facial bone ( thickness & sclerotic of facial bone & skull base, obliteration of sinus maxillaries)
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B. Osteogenesis Imperfecta :
consisted of 2 type congenital (since born) & tarda (the symptoms seen in childhood)
Rontgen :
skull: - thin tabula + warmian bone
Protrusio acetabuli
But Corpus Vertebra still normal Roentgen :
Shortened of long bone & symetries (mycromelia)
The Proximal bone shorter than distal bone (rhizomelia) humerus shorter than radius, femur shorter than tibia
Metafise wide & cupping (in the distal long bone)
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4. The finger bone short & more wide . For example 3rd finger & 4th finger are same (trident hand)
5. Column Vertebrae : wedge (vertebra lumbal), posterior margin of column vertebrae become concave so that the foramen intervertebrale more wide, diameter AP of pedicle become shorter
6. Head bigger (branchycephaly)
7. Fibula head longer than tibia (same as ulna and radius)
8. Pelvic bone “champagne” shape (acetabular angle leveling off)
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May benign or malignant and may primer or secondary (metastasis) :
To differentiated the tumor is malignant or not
Age
How long the pain & the swelling and the growth of the tumor (slowly or fast)
Size of the tumor
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5. Location (what part of the bone)
6. Density : osteolitic, osteosclerotic & mixed
7. Structure of tumor : the margin, the type of destruction (central/marginal),type of periosteal reaction, continuity of the cortex
8. Bone shape : bowing, fracture
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0 - 5 years : neuroblastoma
10 - 25 years : osteosarcoma
20 - 70 years : lipoma
30 - 45 years : fibrosarkoma
30 - 60 years : chondrosarcoma
30 - 70 years : hemangioma
There are 3 principal point in bone lesion assessment :
* infection or neoplasma
* benign or malignant
*primer or secondary
osteoma, osteoblastoma
b. Malignant ( Chondrosarcoma )
b. malignant : Fibrosarkoma
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1. Vessels : Hemangioma, Glomus Tumor, Hemagiosarcoma
2. Nerve : Neurofibroma, Neuroblastoma,
D. Unknown :
b. Malignant : Ewing Tumor
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Sclerotic bone island in the distal femur & proximal portion of tibia
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- size ± 2.5 Cm
& homogen
Tibia
margin
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bone
Ro :
cortex trabecula penetrate into medulla
trough the defect of the cortex )
- Calcification
- Pelvic & scapula irregular & high density
Cauliflower app.
Sometimes multifocal in hand
Ro :
Eccentric in the tip of long bone
No calcification/occification except after patologic fracture
Typical finding : trabeculation like“Soap Bubble App”→40% of cases
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Cortical thinning & expansion
Angiography hypervascular, with many vessels & shunting arteriovenosa
DD : Aneurysmal Bone cyst, chondroblastoma,Fibrous Dysplasia
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affect to children, sites long bone
in vertebrae age 10-20 years, especially at arcus neuralis, rarely at corpus. Commonly multiple vertebrae
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Size varying 2-20 cm
“Soap Bubble Appearance”
Trantition zone between lesion & medulla, sometime with sclerotic. Similar with osteoclastoma. Sometime scalloped atau irreguler, sclerotic margin
Angiography similar with Osteoclastoma
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Aneurysmal bone cyst involving the distal metaphysis & epiphysis of femur
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Man > woman
Position of lesion : metafise / dyafise
50% sclerotic, may osteolytic, mixed (irregular margin )
Periosteal reaction “sunburst”/”Sun Ray” app.
Other Typically : cortex destruction & invasion to soft tissue
Soft tissue swelling
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Often in medulla
Expansion of cortex
Periosteal reaction No/rarely
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Ro :
cannot be differentiated
Codman Triangle
Ro :
Many calcification
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6. MM (Multiple Mieloma)
Ro :
Inner cortex scalloping
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sites of metastasis :
( OSTEOCHONDRITIS, OSTEOCHONDROSIS,BONE INFARCTION)
abnormality of bone which one of the bone loss of vascularity make the sel dead osteonecrosis
Commonly no infection
medium difuse osteoporosis, normal density in the avascular area
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Late stage :
Big joint (microfracture of the cortex hip & shoulder, follow by trabecula compression & colaps that make joint more horizontal with subarticular growth and in same time the trabecula depressed into smaller space.
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Infark metafise & subarticular infarct lucent in the central
“Bone within Bone” linier density in the bone & paralel with cortex
Abnormality of epifiseal “Cone epiphyse” premature fusion
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Tibia/apophysis tibia osgood schlatter
Colcaneus apophysis sever disease
Osteoporoses
Defenition
Systemic skeletal diseases decrease of bone mass & microstructure caused bone more weak & more easier to have fracture
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- Metacarpal
5. Pheripheral Quantitative Computed Tomography (POCT)
6. Dual Energy X-Ray Absorptiometry (DXA)
7. Sonodensitometri
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8. DEGENERATIVE JOINT DISEASES
- Spur may in-growth (foramen Intervertebralis usually cervical (C5,C6,C7) neurologic sign
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Always narrowing of joint space
Irreguler of joint (the margin)
Herbendens Nodes at dorsal facies of distal phalangs (base) spurformation
Subchondral cyst like defect
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Spur formation : condylus tibia proximal,femur distal, eminentia intercondyloidea tibia
Narrowing of joint space medial aspect (DD.Rheumatoid :all joint)
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Ankylosing at interphalangeal joint
Destruction artriris at interphalangeal joint of feet thumb
Mild osteoporosis
Bone mineralisation is normal
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Rontgen :
sklerosing/ankylosing (bilateral)
Squaring anterior corpus vertebrae
Bamboospine
Rontgen :
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Periarticular Osteoporosis cartilage destruction
Ankylosing + subluxatio
Ulnar deviation of finger caused of subluxatio ( flexi extensi → swan neck Appearance )
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RHEUMATOID ARTHRITIS WITH SCLERODERMA
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Radiologic change after multiple attack
Commonly only one joint metacarphalangeal joint ( but other joint in hand & leg can be attacked)
Deposite of Na. urat not radiopact (not seen ,just periarticular & joint swelling)
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Osteolytic juxta articular small/big with good defined
Subarticuler cystic area sclerotic margin Over hanging edge,D±0,3-3 cm PUNCHED OUT
If there are deposite ca in tophy the tophy is seen
Narrowing joint space
Decrease of Osteoporosis
Suture more wide