General MSK

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General MSK

• Laurie Lomasney, MD
• Professor
• Department of Radiology

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General MSK

• Disease Categories
• Arthropathy
• Infection
• Congenital
• Vascular
• Tumor
• Locale
• Axial
• Appendicular

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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

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General MSK

• Disease Categories
• Arthropathy
• Infection
• Congenital
• Vascular
• Tumor

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Arthropathy

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

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Arthropathy
Rheumatoid Arthritis
Periartic demin
Prox/Symmetric swelling
Wrist/MCP erosions
Palmar/Ulnar deviat
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Arthropathy
Psoriasis
Preserved density
Asymmetric swelling
Prox Distal asymm erosions
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Arthropathy
Osteoarthritis
Variable density
No erosions
Eccentric joint narrow
Marginal proliferation
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Arthropathy
Preserved density
Debris
Sclerosis
Malalignment
Charcot Arthropathy
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General MSK

• Disease Categories
• Arthropathy
• Infection
• Congenital
• Vascular
• Tumor

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Infection

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

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Infection
Metaphyseal osteomyelitis
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Infection
DIP Pyarthrosis
Hip Pyarthrosis
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General MSK

• Disease Categories
• Arthropathy
• Infection
• Congenital
• Vascular
• Tumor

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Congenital

• Variable appearance
• Variable consequence
• Incidental
• Pathologic
• Always
• Sometimes
• Unknown

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Congenital

• Ossification neural groove

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Congenital
Os Acromiale
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Congenital
Os tibiale externum
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Congenital
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Narrow Bony Canal
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General MSK

• Disease Categories
• Arthropathy
• Infection
• Congenital
• Vascular
• Tumor

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Vascular (Avascular necrosis)

• Multiple etiologies
• Steroid therapy
• Collagen vascular disease
• Post-traumatic
• Staged appearance
• Sclerosis
• Collapse
• Secondary osteoarthritis

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Avascular necrosis
Lunate AVN
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Avascular necrosis
Femoral head AVN
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General MSK

• Disease Categories
• Arthropathy
• Infection
• Congenital
• Vascular
• Tumor

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Tumor

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

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Tumor

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

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Tumor
Non-ossifying fibroma
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Tumor
Giant cell tumor
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Tumor
Enchondroma
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Tumor
Chondrosarcoma
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Tumor
Osteogenic sarcoma
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Tumor
Osteosarcoma Gross pathology
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General MSK

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

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You know youre 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.

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Thank you

• Laurie Lomasney, MD