Bubbly or lytic lesions (FEGNOMASHIC): fibrous dysplasia (no periosteal reaction, mention adamantinoma if in tibia or jaw; pelvis, proximal femur

, 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

MFH. malignant fibrous histiocytoma (mention with fibrosarcoma. aggressive. reticulum cell sarcoma (primary lymphoma of bone. radiation ± OSA. HPT (healing brown tumor).Lesions that have no pain or periostitis (FENS): fibrous dysplasia. cartilaginous tumor Wide zone of transition (permeative): mets + myeloma. mets. leukemia/lymphoma. osteomyelitis with draining sinus ± SCC. reticulum cell sarcoma. mets in children (neuroblastoma. AVN. infection. looks like Ewing¶s sarcoma. MFH. pigmented villonodular synovitis (hemosiderin deposits lining synovium. MFH. NOF. synovial sarcoma (usu extraarticular). age 30-40 ± GCT (if lung mets or recurrence). infection. NOF. EG. no joint space narrowing). Wilm¶s). elbow. fibrous dysplasia. enchondroma. infection. clivus. erosions. age>40 . EG. bone infarct ± fibrosarcoma. osteochondroma . synovial osteochondromatosis (multiple Ca++ loose bodies. RA. ribs. parosteal form is low-grade and seen in posterior distal femur with more mature ossification centrally). jt destruction. EG Permeative lesion in older pt: infection. SBC Bony sequestrum (FILE): fibrosarcoma. telangiectatic form purely lytic and simulates ABC. aggressive periosteal reaction with Codman triangle or sunburst pattern. trauma Sclerotic lesion age 20-40: chondroblastoma. erosions. enchondroma. often asx) Permeative lesion in child: Ewing¶s sarcoma. EG Malignant bone tumors: age<30 ± Ewing¶s sarcoma (diaphysis long bones > flat bones. giant bone island. chondrosarcoma (pain. lymphoma. pelvis. malignant fibrous histiocytoma. chondrosarcoma. parosteal osteosarcoma (densest calcification is central). reticulum cell sarcoma Soft tissue tumors: MFH. osteoid osteoma (mimic) Geodes (CARD): CPPD. OSA. jt effusion. DJD. Ewing¶s sarcoma. Maffucci¶s ± chondrosarcoma. SBC. striated vertebral body) Malignant transformation of bony lesions: fibrous dysplasia ± fibrosarcoma. ABC. knee. most metaphyseal). long bones. age>40 ± mets + myeloma.chondrosarcoma . fibrosarcoma (almost always lytic). osteoid osteoma. liposarcoma (may or may not have fat).mets Endosteal scalloping: fibrous dysplasia. hemangiomas (phleboliths. medullary location). cortical holes. infection. destruction. myeloma. osteosarcoma (poorly defined intramedullary metaphyseal mass lesion extends through cortex. ST mass typical. aggressive. osteoid or chondroid matrix. Paget¶s ± OSA. mimics PVNS if not Ca++). large soft tissue mass). Ollier¶s ± chondrosarcoma. hip.

syndesmophytes Sacroiliac joint involvement: AS (bamboo spine. periostitis. IP joint great toe). gout. bone destruction. osteoid osteoma Mets to bone: PBKTL. Reiter¶s syndrome (like psoriasis but feet>hands. pencil-in-cup. subchondral cysts. carpal instability. hemangiomas Focal cortical thickening: stress fracture. secondary DJD ± severe JSN out of proportion to sclerosis and osteophytes Hallmarks of HLA-B27 spondyloarthropathies: bony ankylosis. K ± purely lytic. gull-wing erosive pattern). PVNS. secondary OA) Arthropathy distribution in hands and wrists: distal ± psoriasis. subchondral cysts. Salmonella in SCD. crosses disc space in spine. Andersen lesion and pseudoarthrosis). CPPD. DJD. osteophytes. sausage digit. osteoarthritis. unilateral or asymmetric SI jt ± exclude AS and IBD and consider psoriasis and Reiter¶s Large joint involvement: DJD (superolateral migration in hips. periosteal reaction. B ± mixed. ulnar deviation. infection (Staph aureus most common. HPT. amyloidosis (nodular synovitis with erosions resembling RA). proliferative erosions. synovial osteochondromatosis. pubic symphysis Hallmarks of RA: soft tissue swelling. AS (resembles RA). marginal erosions (including ulnar styloid and triquetrum. P ± mostly blastic. protrusio acetabuli. joint space narrowing. arthritis mutilans deformities. CPPD Bilateral symmetry of arthropathy: primary OA (middle-aged women in hands only. acroosteolysis. SI. medial compartment of knee most affected). RA. infection. sequestrum). 1st CMC. periarticular and diffuse osteoporosis. generalized osteoporosis. AC. joint destruction. bilaterally symmetric. STS. Reiter¶s syndrome.Cortical holes (pseudopermeative lesion): osteoporosis (metacarpal cortex less then ¼ to 1/3 of metacarpal). proximal distribution (hands). bony ankylosis. disc calcifications. ochronosis (DSN with vacuum. axial migration. multicentric . Brodie¶s abscess is well-defined lytic lesion with thick sclerotic border. TL ± mostly lytic Hallmarks of DJD: joint space narrowing (asymmetric). predominantly axial (spinal) involvement. distal clavicle resorption. infection. RA (axial migration in hips). radiation. may see rice bodies in synovial inflammation. psoriasis (distal predominance. A-a subluxation. lack of osteoporosis or erosions Joints that exhibit erosions with OA: TMJ. proximal ± RA. bilateral + symmetric SI jt + marginal symmetric syndesmophytes ± usually AS or IBD. rotator cuff tear. heel spur with fuzzy margins). IBD (like AS). subchondral sclerosis. joint effusion. proliferative new bone formation.

hemophilia. Ca++ common). trauma Normal mineralization: DJD. heterotopic new bone. erosions generally not present. collagen vascular diseases.widespread ST calcifications. spinal cord injury. sickle cell anemia. OCD at lateral aspect of medial femoral condyle. subchondral lucency. SONK in elderly at weight bearing medial femoral condyle . paralysis Hallmarks of AVN: increased bone density at otherwise nl jt.ulnar deviation of phalanges. joint destruction from secondary DJD (shoulder. alcohol abuse. enlarged trochlear notch. synovial osteochondromatosis Hallmarks of gout: well-defined erosions often with sclerotic borders or overhanging edges. joint effusion. hemochromatosis (DJD 2nd-4th MCP jts with squaring of metacarpal heads with drooping osteophytes. short metacarpals). dermatomyositis . can present as pseudogout CPPD-associated disorders: primary HPT. radial subluxation of IP joint of thumb Charcot joint: joint destruction. infection. talus. pseudotumor ± large ST mass with adjacent bone destruction. capitellum. PVNS. scleroderma ST calcifications. gout. subchondral cysts. gout. severe resorption of 1st CMC with radial subluxation of 1st metacarpal. periosteal new bone formation. multicentric reticulohistiocytosis. CPPD. causes ± DM. subchondral cysts. random distribution in hands without marked osteoporosis. pubic symphysis). SLE . myelomeningocele/syringomyelia Epiphyseal enlargement and gracile diaphyses: hemophilia (hemarthrosis. preserved joint space. elbow. renal disease. RA. steroids. STS. radiocarpal jt. patchy or mottled density. nonerosive. widened intercondylar notch. secondary OA. resembles Jaccoud¶s arthropathy. cartilage calcification (knee. olecranon/prepatellar bursitis Hallmarks of CPPD: pain. podagra (1st MTP jt). articular surface collapse and joint fragmentation. idiopathic. synovial (synovial osteochondromatosis. soft tissue nodules that calcify in presence of renal failure. dislocation. PVNS). low signal serpiginous border on MR. often have chondrocalcinosis. hematoma. JRA (diffuse ankylosis of posterior articular joints. generalized osteoporosis) Hallmarks of collagen vascular diseases: osteoporosis and soft tissue wasting in the hands.reticulohistiocytosis (multiple erosions predominantly in phalanges without osteoporosis) Monoarticular arthritis: CHRIST ± crystal arthropathies. patellofemoral jt). acroosteolysis. alcoholism. causes ± trauma. triangular fibrocartilage of wrist.

diploic widening. discogenic vertebral sclerosis (variant of Schmorl¶s node). avulsion injury (cortical irregularity and periostitis at ligament or tendon insertion site. straight angle mandible). venous stasis (lower extremities). cotton wool skull. metacarpals and phalanges. Paget¶s disease (bony enlargement. pseudocyst of humerus (lytic area at greater tuberosity). ST calcifications. scapula). os odontoideum (smooth well-corticated inferior border of dens and hypertrophied densely . Looser¶s fxs (femur. protrusio acetabuli. benign fibrous tumor of pleura. salt and pepper skull. pelvis. papillary necrosis). pseudodislocation of humerus (inferior subluxation from fracture and hemarthrosis). HPO (painful periostitis of long tubular bones. fracture (if not immobilized). physiologic. ivory vertebral body. osteopetrosis (³bone in bone. causes . ulna. widened sutures. normal variants ± dorsal defect of patella (lytic defect upper outer quadrant). hair on end skull. mesothelioma. erlenmeyer flask. sacrotuberous ligament) ± 3MsPROOF Periostitis without underlying bony lesion: trauma. osteomyelitis. cortical desmoid (posteromedial epicondyle of femur). neuroblastoma. esp ulnar aspect of 5th metacarpal). mastocytosis (thickened SB folds with nodules). mandible).Hallmarks of osteomalacia: osteopenia. thickened trabeculae. trauma. lesser trochanter avulsion suggests mets). mets (breast and prostate). lytic phase with flame-shaped or blade of grass leading edge that always starts at end of bone except in tibia. bending of long bones Hallmarks of HPT: subperiosteal resorption in radial aspect of middle phalanges. athletes. cholelithiasis. SI jts.lung cancer. rugger jersey spine. dense base of skull). sclerosis. pachydermoperiostosis (like HPO but rarely painful) Periosteal reaction in children: scurvy (dense metaphyseal lines). fluorosis (ligamentous calcification. osteoporosis circumscripta. dactylitis. mets. osteomalacia). bowing of bones). myelofibrosis (splenomegaly and extramedullary hematopoeisis). lymphoma. H shaped or fish vertebrae. tufts absent. medial aspect of proximal tibia. thyroid acropachy (occurs post thyroidectomy. Caffey¶s (tibia. prostaglandins . pyknodysostosis (distal phalanges pointed and dense. geodes. epiphyseal flaring and irregularity. 2o OSA. sickle cell disease (bone infarcts. hypervitaminosis. brown tumors. sandwich vertebrae´. infection. commonly in pelvis with thickened iliopectineal line. picture frame vertebral body. spleen autoinfarction. AVN hip. chondrocalcinosis Dense bones: renal osteodystrophy (2o HPT. leukemia. chronic pulmonary infection).SCALP Don¶t Touch´ lesions: posttraumatic lesions ± myositis ossificans (peripheral circumferential calcification with lucent center). distal clavicle resorption.

line through lateral femoral neck does not intersect with portion of epiphysis. osteopetrosis . can be complication of hypothyroidism). skull. cortical thickening midshaft of long bones involving both periosteal and endosteal surfaces). intraosseous lipoma (asx. OPLL (C-spine). pointed proximal 5th metacarpal base with notch appearance to ulnar aspect. posterior vertebral body scalloping). trabeculae extend into nl bone spiculated). can be on concave side of painful scoliosis. lesion grows away from joint. bone islands (asymptomatic. asymptomatic). pyknodysostosis. flared iliac wings and broad femoral necks. SBC (do not prophylactically curettage if in calcaneus). Poland¶s syndrome (absence of pectoral muscles and syndactyly). may have central calcified nidus). benign lesions ± NOF. follows sclerotome). melorrheostosis (thickened cortical new bone like ³dripping candle wax´. meningioma. congenital rubella (³celery-stalk´ metaphysis) Dense base of skull: fibrous dysplasia. severe patchy osteoporosis and STS following minor trauma). age<30. tarsal coalition (talar beak. self-limited. proximal femur. osteopoikilosis (hereditary. SCFE (overweight teenage boys. asymptomatic. undertubulation. lucent nidus surrounded by reactive sclerosis in cortex of long bone. proximal femur. Engelmann¶s disease (kids. osteopathia striata (multiple 2-3mm thick linear bands of sclerotic bone aligned parallel to long axis of bone. posterior vertebral body scalloping. osteoid osteoma (pain. heel pad thickening). low T1 signal. elongated and widened vertebral bodies. sclerosis of middle facet of subtalar joint). axial more prone to degeneration). calcaneus. usually oblong with long axis in axis of stress. osteoma (facial bones. ³double density´ sign on bone scan). hypertrophied terminal tufts with spade appearance. metaphyseal. Pitt¶s pit (lytic lesion at lateral aspect of femoral neck). bone infarct (dense serpiginous border). Gardner¶s) Miscellaneous bone lesions: achondroplasia (shortened long bones with narrowing of interpedicular distance in caudal direction. knees. DISH (flowing anterior osteophytes at least 4 contiguous vertebral bodies without DSN or sclerosis). sarcoid (³lace-like´ pattern of bony destruction in hands). Paget¶s disease. Von Buchem¶s disease (adults). pseudocyst of calcaneus. reflex sympathetic dystrophy (=Sudeck¶s atrophy.corticated anterior arch of C1). enlarged sinuses and sella turcica. multiple small sclerotic densities on ends of long bones and pelvis). acromegaly (skull thickening. mucopolysaccharidoses (flattened vertebral bodies with anterior beak. multiple hereditary exostosis (osteochondromas. transient osteoporosis of the hip (pain. posterior vertebral body scalloping). hot on bone scan). fibula.

electrical burns. POOF High-riding shoulder: RA. TS. FD. SCD. tabes dorsalis. Marfan¶s. infection. epidermoid inclusion cyst. supernumerary teeth). cleidocranial dysplasia (absent distal clavicles. MeckelGruber Short 4th metacarpal: idiopathic. hemangioma Wormian bones: pyknodysostosis. acromegaly Posterior spinal fusion: Klippel-Feil.dwarf. surgical fusion. Down¶s ± PORKCHOPS Atlanto-axial subluxation: RA. trisomy 13. trauma. infection. mets. epiphyseal dysplasia. HLA-B27. HPT. trauma. myeloma. pachydermoperiostosis. others (inferior) ± Hurler. Paget¶s. Down¶s. osteomyelitis. spinal canal tumor. osteonecrosis (with vacuum disc phenomenon) Anterior vertebral body beaking: Morquio¶s (middle). HPT. pseudohypoparathyroid (brachydactyly). chromosomal anomalies (Turner¶s) ± HITDOC Radial hypoplasia: VACTERL. mets. syrinx. NF Madelung¶s deformity: Hurler¶s. myeloma. infection.Lytic skull lesion: SCD. pyknodysostosis ± PINCH. Turner¶s. osteochondromatosis. Morquio¶s. mets. torn rotator cuff Distal clavicle resorption: RA. osteoid osteoma Platyspondyly: diffuse . HPT. dyschondrosteosis. vascular disease. hypothyroidism. sarcoid. Raynaud¶s. achondroplasia. LIMP. band-like ± polyvinyl chloride. HLA-B27 . GCT. frostbite. OI). chondroectodermal dysplasia. Hajdu-Cheney syndrome Lytic finger: enchondroma. JRA. myeloma. trauma. hemangioma. dural calcifications) Sclerotic vertebral body: LIMMP ± lymphoma. osteoporosis. HPT. Morquio¶s. scleroderma Inferior rib resorption: vascular impression (coarctation). glomus tumor (pain. pseudopseudohypoparathyroid. weightlifting. OI. OI. thrombocytopeniaabsent radius syndrome Ulnar variance: negative ± Kienbock¶s. ABC. Paget¶s Vertebral body lesion: Paget¶s. EhlersDanlos). congenital (achondroplasia. mucopolysaccharidoses. trauma. myeloma. psoriasis. lymphoma. SCD. infection. Holt-Oram syndrome. solitary or multifocal ± EG. erosive arthropathy Polydactyly: familial. CPPD. mets. EG. basal cell nevus syndrome (mandibular cysts. TB. infection. Cushing¶s. ulnar impingement syndrome Distal tuft resorption: scleroderma. epidermoid. leukemia. terminal phalanx). Downs Posterior vertebral scalloping: dural ectasia (NF. positive ± TFCC tear. osteoblastoma. EG. HPT.

plasmacytoma. ABC. fibrous dysplasia.CHONG Gracile bones: NF. chordoma (sacrum. mets. multiple myeloma Epiphysis: chondroblastoma. NiemannPick. Ewing¶s sarcoma. extramedullary hematopoeisis). dysplasias ± NIMROD Bowed bones: rickets. Paget¶s. Erlenmeyer flask) ± ASEPTIC LEG Medial tibial spur: osteochrondroma. OI. hemophilia. osteogenesis imperfecta.Fused vertebrae: isolated. immobilization. chondrosarcoma Metaphysis: osteosarcoma. AVN. synovial osteochondromatosis (multiple calcified loose bodies in jt. infection. ABC. NOF. parosteal sarcoma. Gaucher¶s . preserved joint space). muscular dystrophy. AVN Protrusio acetabuli: RA. trauma. Blount¶s disease. lymphoma Lytic sacrum: met. Klippel-Feil Lytic ilium: FD. OI. JRA. enchondroma. infection. AS. GCT Widened pubic symphysis: bladder exstrophy. osteopetrosis. pigmented villonodular synovitis (erosions. mets. lead. reticulum cell sarcoma Metadiaphyseal: fibrosarcoma. clivus. healing rickets. Ewing¶s. SBC. GCT (after physis closure). chondrosarcoma. fibrous dysplasia Osteopenia: steroids. IBD ± PROT A Femoral head AVN: alcohol. chondromyxoid fibroma . osteochondroma Diaphysis: myeloma. pancreatitis. LCP. vertebral bodies. hemoglobinopathies including SCD and thalassemia (marrow hyperplasia. NF. trauma. trauma. hair-on-end skull. EG. trauma Dense metaphyseal lines: growth recovery lines. osteoporosis. chondrosarcoma. mimics PVNS if noncalcified). chondrosarcoma. osteomalacia. pregnancy Widened teardrop in hip: infection. osteomalacia. FD Soft bone: Paget¶s. pregnancy. SCD. Gaucher¶s (hepatosplenomegaly. trauma. trauma. osteomalacia. SBC. exogenous steroids or radiation. fibrosarcoma. osteopenia. Caisson. expansile lytic lesion with large ST component and variable calcifications). scurvy Erlenmeyer flask: craniometaphyseal dysplasia. GCT (before physis closure). epiphyseal dysplasia. Erlenmeyer flask. osteoid osteoma. plasmacytoma.

acromegaly. ST tumor. vascular Tendon rupture: steroids. liposarcoma. mets. DM. hemangioma. obesity. infection Massive osteolysis: palmar fibromatosis (Dupuytren¶s contracture). metastatic calcifications. myositis ossificans progressiva. leiomyosarcoma. ST atrophy). hematoma. aneurysm Soft tissue calcification: tumoral calcinosis. dilantin. particle disease. callus. aggressive primary bone or ST tumor. peripheral edema . nerve sheath tumor. synovial osteochondromatosis. gout Heel pad thickening: >25mm. RA.MADCOP Periprosthetic lucency: loosening. lipoma. infection . HPT. HPT. CPPD. scleroderma. myxedema. Gorham¶s disease (regional lysis by angiomatous tissue. myositis ossificans. hematoma. tapering of remaining bone. synovial sarcoma. abscess. dermatomyositis.Soft tissue mass: MFH. rhabdosarcoma. calcium hydroxyapatite deposition. mets.

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