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, ribs, skull, long lesion in long bone, expansile medullary lytic lesion, ground glass, well-defined sclerotic margin, bowing deformities, base of skull sclerotic, hot on bone scan, cherubism in mandible and maxilla, craniofacial in facial and frontal bones, pseudoarthrosis of tibia, Mccune Albright is polyostotic FD with café-au-lait spots with precocious puberty), enchondroma (must have calcifications except in phalanges, no periostitis; tubular bones, chondroid calcifications, endosteal scalloping, pain is malignant, Ollier¶s enchondromatosis, Mafucci¶s enchondromatosis with multiple ST hemangiomas), EG (age<30; lytic lesion can look aggressive, skull lesion beveled-edge appearance, sequestrum, floating tooth, vertebra plana, lung dz, pituitary, RES), GCT (epiphyses must be closed, must be epiphyseal and abut the articular surface in long bones, eccentric, welldefined but nonsclerotic border except in flat bones; long tubular bone > spine or sacrum, 50% at knee), NOF (age<30, no periostitis, cortically based; metaphysis), osteoblastoma (mention with ABC even if age>30, especially in posterior elements of spine), mets (age>40; renal and thyroid), myeloma (age>40; plasmacytoma in ilium and sacrum, cold on bone scan; vertebral bodies destroyed before pedicles, axial skeleton, long bones, punched-out lytic lesions, generalized osteopenia, skeletal survey more sensitive), ABC (age<30, expansile, eccentric, pain, fluid-fluid levels on MR; posterior elements of spine, metaphysis of long bones, pelvis), SBC (age<30, central, no periostitis; proximal humerus, proximal femur, calcaneus, fallen fragment sign), HPT (brown tumor, must have other evidence of HPT), infection (always mention), chondroblastoma (age<30, epiphyseal), chondromyxoid fibroma (mention with NOF, no calcified matrix) Automatics (must mention in every case): age<30 ± infection, EG; age>40 ± infection, mets, myeloma Multiple lytic lesions (FEEMHI): fibrous dysplasia, enchondromas, EG, mets, myeloma, HPT, infection Rib lesions (FAME): fibrous dysplasia, ABC, mets, myeloma, enchondroma, EG Lytic epiphyseal lesion (also apophyseal, carpal and tarsal bones, patella): chondroblastoma, infection, EG, GCT, geode; age>40 ± add mets and myeloma and remove chondroblastoma Lytic lesion in posterior elements of spine (OAT): osteoblastoma, ABC, TB Exclude these lytic lesions if age>30 (CANES): chondroblastoma, ABC, NOF, EG, SBC
reticulum cell sarcoma. enchondroma. DJD. mimics PVNS if not Ca++). bone infarct ± fibrosarcoma. looks like Ewing¶s sarcoma. hip. osteoid or chondroid matrix. age>40 ± mets + myeloma. cortical holes. often asx) Permeative lesion in child: Ewing¶s sarcoma. telangiectatic form purely lytic and simulates ABC. cartilaginous tumor Wide zone of transition (permeative): mets + myeloma. malignant fibrous histiocytoma. no joint space narrowing). MFH. chondrosarcoma (pain. large soft tissue mass). NOF. EG. synovial sarcoma (usu extraarticular). radiation ± OSA. osteomyelitis with draining sinus ± SCC. osteochondroma . infection. lymphoma. EG. fibrous dysplasia. clivus. RA. hemangiomas (phleboliths.mets Endosteal scalloping: fibrous dysplasia. SBC. osteoid osteoma. age>40 . liposarcoma (may or may not have fat). aggressive periosteal reaction with Codman triangle or sunburst pattern. osteosarcoma (poorly defined intramedullary metaphyseal mass lesion extends through cortex. Ollier¶s ± chondrosarcoma. knee. EG Malignant bone tumors: age<30 ± Ewing¶s sarcoma (diaphysis long bones > flat bones. reticulum cell sarcoma Soft tissue tumors: MFH. medullary location). Maffucci¶s ± chondrosarcoma. destruction. aggressive. MFH. Paget¶s ± OSA. jt effusion. most metaphyseal). chondrosarcoma. synovial osteochondromatosis (multiple Ca++ loose bodies. giant bone island. aggressive. mets in children (neuroblastoma. infection. AVN. age 30-40 ± GCT (if lung mets or recurrence). parosteal osteosarcoma (densest calcification is central). infection. NOF. elbow. enchondroma. pelvis. ABC. SBC Bony sequestrum (FILE): fibrosarcoma. long bones. osteoid osteoma (mimic) Geodes (CARD): CPPD. leukemia/lymphoma. erosions. Wilm¶s). myeloma. parosteal form is low-grade and seen in posterior distal femur with more mature ossification centrally). fibrosarcoma (almost always lytic). trauma Sclerotic lesion age 20-40: chondroblastoma. pigmented villonodular synovitis (hemosiderin deposits lining synovium.Lesions that have no pain or periostitis (FENS): fibrous dysplasia. MFH. malignant fibrous histiocytoma (mention with fibrosarcoma. jt destruction. Ewing¶s sarcoma. HPT (healing brown tumor). mets. reticulum cell sarcoma (primary lymphoma of bone. erosions. infection. ribs. OSA. EG Permeative lesion in older pt: infection.chondrosarcoma . ST mass typical. striated vertebral body) Malignant transformation of bony lesions: fibrous dysplasia ± fibrosarcoma.
radiation. hemangiomas Focal cortical thickening: stress fracture. heel spur with fuzzy margins). proximal ± RA. subchondral cysts. HPT. sequestrum). SI. sausage digit. protrusio acetabuli. marginal erosions (including ulnar styloid and triquetrum. CPPD Bilateral symmetry of arthropathy: primary OA (middle-aged women in hands only. Brodie¶s abscess is well-defined lytic lesion with thick sclerotic border. arthritis mutilans deformities. periostitis. RA (axial migration in hips). periosteal reaction. may see rice bodies in synovial inflammation. crosses disc space in spine. bone destruction. unilateral or asymmetric SI jt ± exclude AS and IBD and consider psoriasis and Reiter¶s Large joint involvement: DJD (superolateral migration in hips. P ± mostly blastic. amyloidosis (nodular synovitis with erosions resembling RA). RA. B ± mixed. gull-wing erosive pattern). ochronosis (DSN with vacuum. pubic symphysis Hallmarks of RA: soft tissue swelling. predominantly axial (spinal) involvement. 1st CMC. infection (Staph aureus most common. joint effusion. K ± purely lytic. carpal instability. joint space narrowing. periarticular and diffuse osteoporosis. DJD. Andersen lesion and pseudoarthrosis). secondary DJD ± severe JSN out of proportion to sclerosis and osteophytes Hallmarks of HLA-B27 spondyloarthropathies: bony ankylosis. osteoid osteoma Mets to bone: PBKTL. bony ankylosis. infection. Reiter¶s syndrome. Reiter¶s syndrome (like psoriasis but feet>hands. AC. synovial osteochondromatosis. ulnar deviation. pencil-in-cup. generalized osteoporosis. TL ± mostly lytic Hallmarks of DJD: joint space narrowing (asymmetric). medial compartment of knee most affected). psoriasis (distal predominance. AS (resembles RA). gout. secondary OA) Arthropathy distribution in hands and wrists: distal ± psoriasis. proximal distribution (hands). joint destruction.Cortical holes (pseudopermeative lesion): osteoporosis (metacarpal cortex less then ¼ to 1/3 of metacarpal). STS. IP joint great toe). CPPD. lack of osteoporosis or erosions Joints that exhibit erosions with OA: TMJ. proliferative new bone formation. infection. A-a subluxation. PVNS. osteoarthritis. bilaterally symmetric. proliferative erosions. subchondral cysts. osteophytes. acroosteolysis. rotator cuff tear. syndesmophytes Sacroiliac joint involvement: AS (bamboo spine. axial migration. IBD (like AS). subchondral sclerosis. disc calcifications. multicentric . distal clavicle resorption. bilateral + symmetric SI jt + marginal symmetric syndesmophytes ± usually AS or IBD. Salmonella in SCD.
resembles Jaccoud¶s arthropathy. subchondral lucency. subchondral cysts. cartilage calcification (knee. paralysis Hallmarks of AVN: increased bone density at otherwise nl jt. SONK in elderly at weight bearing medial femoral condyle . subchondral cysts. radiocarpal jt. heterotopic new bone. STS. JRA (diffuse ankylosis of posterior articular joints. OCD at lateral aspect of medial femoral condyle. joint effusion. renal disease. RA. elbow. pseudotumor ± large ST mass with adjacent bone destruction. hematoma. talus. widened intercondylar notch. scleroderma ST calcifications. joint destruction from secondary DJD (shoulder. soft tissue nodules that calcify in presence of renal failure. multicentric reticulohistiocytosis. often have chondrocalcinosis. triangular fibrocartilage of wrist. dislocation. spinal cord injury. gout. preserved joint space. articular surface collapse and joint fragmentation. patellofemoral jt). PVNS. sickle cell anemia. alcoholism.ulnar deviation of phalanges. acroosteolysis. synovial (synovial osteochondromatosis. erosions generally not present. alcohol abuse. steroids. can present as pseudogout CPPD-associated disorders: primary HPT.widespread ST calcifications. dermatomyositis . short metacarpals). nonerosive. trauma Normal mineralization: DJD. periosteal new bone formation. low signal serpiginous border on MR. CPPD. gout. secondary OA. generalized osteoporosis) Hallmarks of collagen vascular diseases: osteoporosis and soft tissue wasting in the hands. pubic symphysis). enlarged trochlear notch. myelomeningocele/syringomyelia Epiphyseal enlargement and gracile diaphyses: hemophilia (hemarthrosis. causes ± DM. capitellum. collagen vascular diseases. hemophilia. severe resorption of 1st CMC with radial subluxation of 1st metacarpal. podagra (1st MTP jt). idiopathic. PVNS). synovial osteochondromatosis Hallmarks of gout: well-defined erosions often with sclerotic borders or overhanging edges. infection. olecranon/prepatellar bursitis Hallmarks of CPPD: pain. SLE .reticulohistiocytosis (multiple erosions predominantly in phalanges without osteoporosis) Monoarticular arthritis: CHRIST ± crystal arthropathies. random distribution in hands without marked osteoporosis. hemochromatosis (DJD 2nd-4th MCP jts with squaring of metacarpal heads with drooping osteophytes. radial subluxation of IP joint of thumb Charcot joint: joint destruction. patchy or mottled density. Ca++ common). causes ± trauma.
picture frame vertebral body. ulna. sickle cell disease (bone infarcts. rugger jersey spine. neuroblastoma. venous stasis (lower extremities). distal clavicle resorption. mesothelioma. lymphoma. mets. medial aspect of proximal tibia. leukemia. osteomyelitis. osteomalacia). lytic phase with flame-shaped or blade of grass leading edge that always starts at end of bone except in tibia. sandwich vertebrae´. widened sutures. athletes. trauma. mandible). bending of long bones Hallmarks of HPT: subperiosteal resorption in radial aspect of middle phalanges. protrusio acetabuli. tufts absent. chronic pulmonary infection). dactylitis. Looser¶s fxs (femur. sacrotuberous ligament) ± 3MsPROOF Periostitis without underlying bony lesion: trauma. pelvis. benign fibrous tumor of pleura. scapula). chondrocalcinosis Dense bones: renal osteodystrophy (2o HPT. spleen autoinfarction. physiologic. papillary necrosis). lesser trochanter avulsion suggests mets).lung cancer.Hallmarks of osteomalacia: osteopenia. infection. discogenic vertebral sclerosis (variant of Schmorl¶s node). os odontoideum (smooth well-corticated inferior border of dens and hypertrophied densely . cotton wool skull. 2o OSA. HPO (painful periostitis of long tubular bones. hypervitaminosis. thickened trabeculae. avulsion injury (cortical irregularity and periostitis at ligament or tendon insertion site. geodes. cortical desmoid (posteromedial epicondyle of femur). epiphyseal flaring and irregularity. pseudodislocation of humerus (inferior subluxation from fracture and hemarthrosis).SCALP Don¶t Touch´ lesions: posttraumatic lesions ± myositis ossificans (peripheral circumferential calcification with lucent center). hair on end skull. SI jts. Paget¶s disease (bony enlargement. metacarpals and phalanges. dense base of skull). mets (breast and prostate). normal variants ± dorsal defect of patella (lytic defect upper outer quadrant). pachydermoperiostosis (like HPO but rarely painful) Periosteal reaction in children: scurvy (dense metaphyseal lines). osteoporosis circumscripta. causes . AVN hip. Caffey¶s (tibia. osteopetrosis (³bone in bone. myelofibrosis (splenomegaly and extramedullary hematopoeisis). H shaped or fish vertebrae. brown tumors. diploic widening. ivory vertebral body. esp ulnar aspect of 5th metacarpal). fracture (if not immobilized). erlenmeyer flask. salt and pepper skull. mastocytosis (thickened SB folds with nodules). pseudocyst of humerus (lytic area at greater tuberosity). thyroid acropachy (occurs post thyroidectomy. prostaglandins . bowing of bones). commonly in pelvis with thickened iliopectineal line. fluorosis (ligamentous calcification. cholelithiasis. pyknodysostosis (distal phalanges pointed and dense. ST calcifications. sclerosis. straight angle mandible).
mucopolysaccharidoses (flattened vertebral bodies with anterior beak. SCFE (overweight teenage boys. flared iliac wings and broad femoral necks. acromegaly (skull thickening. multiple hereditary exostosis (osteochondromas. bone infarct (dense serpiginous border). may have central calcified nidus). cortical thickening midshaft of long bones involving both periosteal and endosteal surfaces). knees. low T1 signal. can be on concave side of painful scoliosis. Paget¶s disease. enlarged sinuses and sella turcica. Engelmann¶s disease (kids. proximal femur. age<30. posterior vertebral body scalloping. line through lateral femoral neck does not intersect with portion of epiphysis. lucent nidus surrounded by reactive sclerosis in cortex of long bone. osteoid osteoma (pain. posterior vertebral body scalloping). sclerosis of middle facet of subtalar joint). ³double density´ sign on bone scan). osteopetrosis . trabeculae extend into nl bone spiculated). Von Buchem¶s disease (adults). DISH (flowing anterior osteophytes at least 4 contiguous vertebral bodies without DSN or sclerosis). hot on bone scan). hypertrophied terminal tufts with spade appearance. OPLL (C-spine). pyknodysostosis. osteopathia striata (multiple 2-3mm thick linear bands of sclerotic bone aligned parallel to long axis of bone. intraosseous lipoma (asx. fibula. self-limited. Poland¶s syndrome (absence of pectoral muscles and syndactyly). SBC (do not prophylactically curettage if in calcaneus). multiple small sclerotic densities on ends of long bones and pelvis). melorrheostosis (thickened cortical new bone like ³dripping candle wax´. usually oblong with long axis in axis of stress. heel pad thickening). osteopoikilosis (hereditary. asymptomatic. pseudocyst of calcaneus. Pitt¶s pit (lytic lesion at lateral aspect of femoral neck). sarcoid (³lace-like´ pattern of bony destruction in hands). can be complication of hypothyroidism). tarsal coalition (talar beak. Gardner¶s) Miscellaneous bone lesions: achondroplasia (shortened long bones with narrowing of interpedicular distance in caudal direction. calcaneus. follows sclerotome). meningioma.corticated anterior arch of C1). osteoma (facial bones. undertubulation. bone islands (asymptomatic. lesion grows away from joint. elongated and widened vertebral bodies. severe patchy osteoporosis and STS following minor trauma). reflex sympathetic dystrophy (=Sudeck¶s atrophy. asymptomatic). axial more prone to degeneration). metaphyseal. benign lesions ± NOF. skull. posterior vertebral body scalloping). pointed proximal 5th metacarpal base with notch appearance to ulnar aspect. transient osteoporosis of the hip (pain. proximal femur. congenital rubella (³celery-stalk´ metaphysis) Dense base of skull: fibrous dysplasia.
HLA-B27 . epidermoid. OI. EhlersDanlos). osteonecrosis (with vacuum disc phenomenon) Anterior vertebral body beaking: Morquio¶s (middle). terminal phalanx). HPT. supernumerary teeth). vascular disease. LIMP. Marfan¶s. Hajdu-Cheney syndrome Lytic finger: enchondroma. pseudohypoparathyroid (brachydactyly). mets. positive ± TFCC tear. osteochondromatosis. osteoblastoma. TB. tabes dorsalis. EG. Downs Posterior vertebral scalloping: dural ectasia (NF. frostbite. chromosomal anomalies (Turner¶s) ± HITDOC Radial hypoplasia: VACTERL. hemangioma. osteomyelitis. surgical fusion. syrinx. lymphoma. Paget¶s.Lytic skull lesion: SCD. Morquio¶s. weightlifting. ABC. myeloma. scleroderma Inferior rib resorption: vascular impression (coarctation). Morquio¶s. Raynaud¶s. GCT. HPT. mucopolysaccharidoses. osteoporosis. MeckelGruber Short 4th metacarpal: idiopathic. CPPD. HPT. glomus tumor (pain. epiphyseal dysplasia. trauma. HPT. band-like ± polyvinyl chloride. dyschondrosteosis. sarcoid. thrombocytopeniaabsent radius syndrome Ulnar variance: negative ± Kienbock¶s. solitary or multifocal ± EG. epidermoid inclusion cyst. hemangioma Wormian bones: pyknodysostosis. Down¶s. Paget¶s Vertebral body lesion: Paget¶s. mets. EG. POOF High-riding shoulder: RA. NF Madelung¶s deformity: Hurler¶s. hypothyroidism. dural calcifications) Sclerotic vertebral body: LIMMP ± lymphoma. OI). Turner¶s. infection. pyknodysostosis ± PINCH. ulnar impingement syndrome Distal tuft resorption: scleroderma.dwarf. acromegaly Posterior spinal fusion: Klippel-Feil. TS. HLA-B27. Down¶s ± PORKCHOPS Atlanto-axial subluxation: RA. achondroplasia. Holt-Oram syndrome. infection. myeloma. trauma. infection. infection. mets. trauma. myeloma. SCD. mets. congenital (achondroplasia. erosive arthropathy Polydactyly: familial. myeloma. infection. FD. HPT. psoriasis. trauma. cleidocranial dysplasia (absent distal clavicles. SCD. Cushing¶s. trisomy 13. spinal canal tumor. pseudopseudohypoparathyroid. OI. osteoid osteoma Platyspondyly: diffuse . chondroectodermal dysplasia. basal cell nevus syndrome (mandibular cysts. pachydermoperiostosis. leukemia. torn rotator cuff Distal clavicle resorption: RA. electrical burns. JRA. others (inferior) ± Hurler.
lead. FD Soft bone: Paget¶s. osteopenia. NiemannPick. hemoglobinopathies including SCD and thalassemia (marrow hyperplasia. osteomalacia. multiple myeloma Epiphysis: chondroblastoma. chondrosarcoma. Paget¶s. mets. mets.Fused vertebrae: isolated. chondrosarcoma. synovial osteochondromatosis (multiple calcified loose bodies in jt. epiphyseal dysplasia. JRA. osteoporosis. chondromyxoid fibroma . immobilization. vertebral bodies. chondrosarcoma Metaphysis: osteosarcoma. SBC. mimics PVNS if noncalcified). Erlenmeyer flask. Blount¶s disease. lymphoma Lytic sacrum: met. dysplasias ± NIMROD Bowed bones: rickets. pregnancy Widened teardrop in hip: infection. ABC. osteoid osteoma. clivus. trauma. pancreatitis. expansile lytic lesion with large ST component and variable calcifications). osteogenesis imperfecta. ABC. hemophilia. Ewing¶s. trauma Dense metaphyseal lines: growth recovery lines. osteomalacia. Klippel-Feil Lytic ilium: FD. osteopetrosis. fibrous dysplasia. plasmacytoma. Gaucher¶s (hepatosplenomegaly. osteochondroma Diaphysis: myeloma. trauma. Ewing¶s sarcoma. extramedullary hematopoeisis). GCT (before physis closure). muscular dystrophy. plasmacytoma. SBC. chondrosarcoma. reticulum cell sarcoma Metadiaphyseal: fibrosarcoma. hair-on-end skull. trauma. scurvy Erlenmeyer flask: craniometaphyseal dysplasia.CHONG Gracile bones: NF. AVN Protrusio acetabuli: RA. healing rickets. infection. OI. Gaucher¶s . GCT Widened pubic symphysis: bladder exstrophy. Erlenmeyer flask) ± ASEPTIC LEG Medial tibial spur: osteochrondroma. exogenous steroids or radiation. pigmented villonodular synovitis (erosions. NOF. SCD. AVN. preserved joint space). infection. osteomalacia. parosteal sarcoma. LCP. EG. NF. Caisson. trauma. OI. fibrosarcoma. fibrous dysplasia Osteopenia: steroids. IBD ± PROT A Femoral head AVN: alcohol. AS. GCT (after physis closure). pregnancy. enchondroma. trauma. chordoma (sacrum.
peripheral edema . synovial osteochondromatosis. Gorham¶s disease (regional lysis by angiomatous tissue. liposarcoma. aggressive primary bone or ST tumor. abscess. vascular Tendon rupture: steroids. calcium hydroxyapatite deposition. scleroderma. infection Massive osteolysis: palmar fibromatosis (Dupuytren¶s contracture). nerve sheath tumor. HPT. metastatic calcifications. acromegaly. rhabdosarcoma. particle disease. mets. leiomyosarcoma. mets.MADCOP Periprosthetic lucency: loosening. ST tumor. callus. myositis ossificans progressiva. ST atrophy). myxedema. RA. hemangioma. gout Heel pad thickening: >25mm. synovial sarcoma. HPT.Soft tissue mass: MFH. dilantin. DM. CPPD. dermatomyositis. hematoma. hematoma. infection . tapering of remaining bone. aneurysm Soft tissue calcification: tumoral calcinosis. lipoma. obesity. myositis ossificans.
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