DXI 3 final
kirner deformity
(dystelephalangy) with incurring (claw-like deformity) of the distal phalanges of both little fingers occurs sporadically with autosomal dominant heredity
clavicle series
- PA clavicle - AP axial (tangential) clavicle can also be done with patient in PA position
standard elbow series
-AP elbow -Medial oblique elbow -lateral elbow
standard shoulder series
-AP with external rotation of humerus -AP with internal rotation of humerus
carpal coalition
-Fusion of 2 or more carpal bones - most common is lunate & triquetrum -capitate & hamate is second most common
standard hand series
-PA hand -Medial oblique hand -lateral hand
standard wrist series
-PA wrist -PA medial oblique wrist -Lateral wrist
accessory views for wrist
-PA wrist with ulnar deviation -carpal tunnel view
accessory views of shoulder
-baby arm projection -grashey spot projection -lateral scapula (Y projection) -AC joint series -clavicle series
scaphoid fat stripe
-extends from the trapezium to the radial styloid process -radiolucency caused by a layer of fat interposed between the radial collateral ligament & the tendons of the extensor pollicis brevis and abductor pollicis longus
sesamoid bones of the hand
-normal to see at 1st & 5th digit -not uncommon to see at 2nd digit -uncommon to see at 3rd & 4th digit
radiocapitellar line
-on a lateral projection, this line is drawn down the center of and parallel to the long axis of the radius, extending through the joint space -line should pass through center of capitulum on all standard views of the elbow
acromioclavicular joint space
-one weighted and one nonweighted projection required -measure joint space between acromion process and clavicle
vacuum phenomenon
-radiolucency noted in the joint space -represents gas within the joint capsule
glenohumeral joint space
-taken from glenoid fossa to the most medial aspect of humeral head -will need to angle patient towards bucky (35-45 AP) with arm in external rotation
coracoclavicular space
-uses AC series or AP shoulder series to evaluate -measure between the top of the coracoid and undersurface of the clavicle
What are the 3 stages of Complex Regional Pain Syndrome?
1. Acute 2. Dystrophic or ischemic 3. Atrophic
What are the four stages of Legg-Calve-Perthes Disease?
1. Avascular 2. Revascularization 3. Repair 4. Deformity
What are the phases of epiphyseal infarction and their radiographic presentations?
1. Avascular - increase in joint space; small epiphysis; normal epiphyseal bone density; +/- metaphyseal osteopenia 2. Revascularization - Epiphyseal sclerosis 3. Repair - reconstitution of epiphysis 4. Deformity - Deformed joint surface; eventual degeneration
In regards to bone death, what parts of bone do the following terms refer to? 1. Avascular necrosis 2. Medullary infarct 3. Cortical infarct
1. Avascular necrosis - Epiphysis 2. Medullary infarct - Medullary space 3. Cortical infarct - Cortex
Locations of these types of osteonecrosis: 1. Blount's Disease 2. Diaz's Disease 3. Hass' Disease 4. Kohler's Disease 5. Macuclaire's Disease 6. Panner's Disease 7. Preiser's Disease 8. Sever's Disease 9. Sinding-Larsen-Johansson Disease 10. Thiemann's Disease
1. Blount's Disease - Medial proximal tibial epiphysis 2. Diaz's Disease - Talus 3. Hass' Disease - Humeral head 4. Kohler's Disease - Tarsal navicular 5. Macuclaire's Disease - Metacarpal Head 6. Panner's Disease - Distal humerus 7. Preiser's Disease - Scaphoid 8. Sever's Disease - Calcaneus 9. Sinding-Larsen-Johansson Disease - Lower patella 10. Thiemann's Disease - Base of phalanges of hands
What are the radiological signs of Osteomalacia?
1. Decreased bone density 2. Coarsened Trabecular Pattern 3. Loss of cortical definition 4. Pseudo-fractures 5. Deformities
Give two examples of why regional osteoporosis might occur in a body part.
1. Immobilization 2. Sudeck's atrophy
What are the radiographic findings of Scheuerman's Disease?
1. Kyphosis to at least 3 contiguous segment with wedge at least 5 degrees 2. Irregular endplates 3. Decreased disc heights
Name the three trabecular patterns on the femoral neck. Which one is the first to recede in osteoporosis?
1. Principal compressive group 2. Secondary compressive group 3. Principal tensile group The principle tensile group is the first to recede in osteoporosis
What are the radiologic features of hemophilia?
1. Soft tissue swelling 2. Osteoporosis 3. Subchondral cysts 4. Expansile Bone Lesions (Pseudo-Tumors) 5. Epiphyseal abnormalities 6. Joint disorganization
What are two other names for complex regional pain syndrome?
1. Sudek's Atrophy 2. Reflex Sympathetic Dystrophy Syndrome
What is the age range and gender predilection for osteochondritis dissecans?
11-20; Male
What is the age range and gender predilection for Freiberg's Disease?
13-18 years old; female
A heel pad greater than ___ mm is suggestive of acromegaly
20 mm
What is the age range and gender predilection for Keinbock's Disease?
20-40 years old; Male
three arcs of carpal alignment
3 parallel arcs 1. along proximal aspect of proximal row 2. along distal aspect of proximal row 3. along proximal aspect of distal row
What is the most common age range and gender predilection for osteonecrosis?
3-10 years old; male
What is the age range and gender predilection for Legg-Calve-Perthes Disease?
3-12: Male
What is the age range and gender predilection for spontaneous osteonecrosis of the femoral head in adults?
30-70: Male
Usually ___ months duration of avitaminosis before symptoms and skeletal changes of scurvy become apparent
4 months
Spontaneous Osteonecrosis of the Femoral Head in Adults can occur bilaterally in ____% of cases
50%
An ADI of up to ___ mm can be considered normal in a patient with acromegaly
6 mm
In which age group does scurvy normally occur?
8-14 months; Eldery with dietary compromise
Shenton's Line
A curved line is drawn along the UNDERSURFACE of the femoral neck and it's continued along under the superior pubic ramus
Tarsal Coalition
A fibrous or osseous union between two tarsal bone
Extrapleural sign
A lesion that originates from the chest wall and extends into the lung field creates tapered margins denoting inward deviation of the pleura. This finding creates a radiographic sign know as _________.
Klein's Line
A line is drawn parallel and off the cortex of the lateral femoral neck
Kohler's line
A tangent line is drawn off of the pelvic brim that runs through the outer aspect of the obturator foramen • Normal: • Medial acetabulum *should fall lateral* to this line
Accessory views (hip)
AP Spot hip (This view is a localized view of the hip and is only done when a question arises from the standard)
Pores of Kohn
Accessory pathways of communication between adjacent alveoli are known as _________.
"Spade-like" distal tufts of the distal phalanges are associated with what condition?
Acromegaly
"Check-valve" bronchial obstruction/air trapping or pneumothorax
An expiratory chest radiography may be beneficial in further assessment of a patient with suspected _________.
Polydactyly
An increase in the number of fingers or toes
If you find a fracture in the pelvic ring what should you always look for?
Another fracture. Ring structures will usually break in another place if there's already a fracture.
Magenblase
Another name for the gastric air bubbles is the _________.
The Distal Femoral Epiphysis
Approximately 5mm at birth Has fringe like margins
Infrapatellar Fat Pad (Hoffa's Fat Pad)
Area of radiolucency between the inferior pole of the patella and the tibial plateaus
Trachea, primary bronchi, respiratory bronchiole, alveolar duct
Arrange the airways from biggest to smallest diameter.
Right upper
Atelectasis of which lobe is associated with the "S" sign of Golden?
What is Legg-Calve-Perthes Disease?
Avascular necrosis of femoral capital epiphysis before closure of growth plates.
Osteonecrosis in sickle cell anemia is often seen ____ (unilaterally/bilaterally)
Bilaterally
Accessory views (foot)
Calcaneus series
How do the vertebral bodies look when the nutrient arteries have been obstructed in a sickling crisis during development?
Central endplates are inwardly displaced because blood can't get to the center of the body. Fig. 13-3 C Page 1429
Spontaneous Osteonecrosis of the Femoral Head in Adults is also called what?
Chandler's Disease
Type 3 (Oc Tibiale Externum)
Characterized by fusion of the ossicle to the navicular, producing an elongated, curved navicular (cornuate navicular). These are rarely significant.
What is an intravertebral vacuum cleft sign?
Collapse of vertebral body due to avascular necrosis collects nitrogen gas within the body
Bilateral Iliac Horns
Congenital anomaly seen as osseous projections from the posterior iliac fossa. Tetrad • Dysplastic fingernails • Hypoplastic / absent patellae • Elbow dysplasia's Combined signs forma syndrome known as the Nail Patella Syndrome • AKA Hood, Fong's, or osteoonychodysplasia)
3
Dilation of the small bowel is evident when the transverse dimension of the small bowel lumen initially exceeds _________ cm.
Teardrop distance
Distance between the femoral head and outer aspect of Kohler's teardrop. looking for (Waldenstrom's sign) Clinical significance: Hip disease
What is platysponydyly?
Elongation of the vertebra. Seen in acromegaly. Visualized on AP films best
In which part of bone does Cushing's Disease and Steroid-Induced Osteonecrosis commonly cause necrosis?
Epiphysis
What part of bone is most susceptible to infarction in osteonecrosis?
Epiphysis
Name the radiographic sign: Widened metaphysis/diaphysis in thalassemia
Erlenmeyer flask
What is thought to cause avascular necrosis in Cushing's Disease and Steroid-Induced Osteonecrosis?
Fat emboli derived from fatty liver
What is the age range and gender predilection for hyperparathyroidism?
Females; 30-50
3-7mm
Femoral-Acetabular Joint Space *Axial*=? Looking for Degenerative arthritis
4-13mm
Femoral-Acetabular Joint Space *Medial*=? Looking for Degenerative arthritis
3-6mm
Femoral-Acetabular Joint Space *Superior*=? Looking for Degenerative joint disease
Meniscal Ossicle
Focal ossification within the meniscus most commonly occurs in the posterior horn of the medial meniscus
A 17 year old female patient presents to your clinic complaining of pain and swelling in the foot. You take radiographs and notice flattening of the 2nd metatarsal head. The cortex appears collapsed. What pathology is likely?
Freiberg's Disease Pg. 1467
The crescent sign in AVN of the femoral head is best seen on which radiographic view?
Frog leg
What is the most common tumor of the patella?
Giant cell tumor
25mm men, 23mm women
Heel pad thickness should not read more than?
Enlargement of epiphysis is associated with which congenital condition?
Hemophilia
You receive knee radiographs of a 25 year old male patient with knee pain. You notice the femoral condyles are grossly enlarged and that there is widening of the intercondylar notch. The tibial epiphysis appears enlarged and lucent. The inferior pole of the patella is squared. You also notice increased periarticular density suggesting soft tissue swelling. What pathology is likely?
Hemophilia Pg. 1435
Which clotting factor is lacking in Hemophilia A? Hemophilia B?
Hemophilia A - Factor VIII Hemophilia B - Factor IX
Brown tumors are associated with which pathology discussed in class?
Hyperparathyroidism
Coarctation of aorta
Hypertrophy of the intercostal arteries causes characteristic inferior rib notching. Which of the following conditions below is responsible for such a finding?
Aortic aneurysm
Identify the condition seen on the image provided.
Protrusio Acetabuli
If acetabulum is located medial when drawing Kohler's line, it's called? Rheumatoid arthritis, and Paget's disease
What differentiates Reflex Sympathetic Dystrophy Syndrome from infection?
In RSDS, the joint margins and spaces are preserved.
Silhouette
In radiographs, obliteration of anatomic borders between tissues of similar density in contact with one another defines the _________ sign.
In sickle cell disease how might the spleen appear in initial stages of the disease vs. late stages?
Initial stage - Enlarged Late stage - Atrophy
How does the intravertebral vacuum cleft sign appear on MRI over time?
Initially - black signal void because of gas Later - High signal on T2 because of fluid infiltration
Where does 80% of bleeding occur in hemophilia?
Inside joints
Scheuerman's Disease can look like infection. How do you differentiate between the two?
Irregular endplates in Scheuerman's Disease may look like infection. Look at the cortex of the bone. They will be intact in Scheuerman's Disease, but probably destroyed in infection
Name the pathology: Avascular necrosis of the carpal lunate.
Keinbock's Disease
A 35 year old male patient presents to your clinic complaining of wrist pain. Upon radiographic examination, you notice osteopenia in the carpal bones except for the lunate which appears sclerotic in comparison. What is the likely pathology? What imaging modality can detect early changes in this pathology?
Keinbock's Disease. MRI can detect the changes much earlier than x-ray.
Retrosternal clear space within the anterior mediastinum
Knowledge of the different radiographic divisions (mediastinal divisions) of the chest is key to the correct differential diagnosis. The region between the sternum and the anterior heart is called the?
Sagging rope sign is seen in what pathology?
Legg-Calve-Perthes Disease Pg. 1465 Fig. 13-47 D
Coxa Vara
Less than 120 degrees when measuring the femoral angel is known as?
Lateral Patellofemoral Joint space
Longer and more horizontal than medial in the knee
If you suspect hemophilia in the joints, what other imaging modality might be useful in confirming your suspicion? Why?
MRI Useful in depicting synovial hypertrophy, inflammation, fluid accumulation, and loss of articular cartilage
What are the three types of thalassemia?
Major, minor, intermediate
Which part of the knee does Spontaneous Osteonecrosis of the Knee usually affect?
Medial condyle of the distal femur
Coxa Valga
More than 130 degrees when measuring the femoral angel is known as?
In Keinbock' Disease, we might see ______ (positive/negative) ulnar variance.
Negative
In terms of joint disorganization, what pathology might radiographically appear similar to hemophilia?
Neurotrophic joint disease
Costophrenic angles
Non visualization of which structure(s) necessitates repeating a PA chest radiograph?
28-40 degrees
Normal Boehler's Angle?
6-11mm (no more that 2mm difference btw sides)
Normal teardrop distance
Femorotibial Joint Space
Normally measure between 3-5mm
Silhouette
On conventional radiography, loss of anatomical borders between structures of similar radiographic density because they are touching is the _________ sign.
A 12 year old male patient presents to your office complaining of knee pain after joining the soccer team. Upon examination, you notice a bump on the tibial tuberosity. What is the likely pathology?
Osgood-Schlatter Disease
Talar Beak
Osseous projection of the talar neck.
OS Cyamella
Ossicle in popliteus tendon
Name the condition: Condition of unknown origin that occurs in children and adolescents that is characterized by a small necrotic segment of subchondral bone.
Osteochondritis Dissecans Pg. 1476
The brim sign is associated with which pathology?
Paget's
Name the radiologic sign: Widened growth plate with irregular, frayed, and cupped metaphyseal margins. Seen in rickets.
Paintbrush sign Fig 14-25 Pg. 1515
Avascular necrosis of the capitellum of the distal humerus is also called what?
Panner's Disease
Multipartite Patella
Patella consists of more than three pieces
Tripartite Patella
Patella consists of three pieces
Patella Alta
Patella ligament greater than 20% longer than patella • Patella is positioned high on femur • May be seen in chondramalacia patella
Name the radiographic sign: These bony protuberances occur at the metaphyseal margins and extend at right angles away from the shaft axis. Seen in scurvy.
Pelken's spurs Fig 14-27 Pg. 1517
What is a DDx for a hemophiliac pseudo-tumor? What is the key in identifying one pathology over another?
Plasmacytoma; mets; giant cell tumor Location
Patella Baja
Potella positioned too low Greatest length of the patella and the length of the patellar tendon • Should be equal 20%
Avascular necrosis of the entire scaphoid is called what?
Prieser's Disease
3.8-6mm
Pubic Symphysis Width: Normal Female =? Never More than 10mm
4.8-7.22mm
Pubic Symphysis Width: Normal Male =? Never More than 10mm
Commonly, in hyperparathyroidism, the _____ (radial/ulnar) side of the 2nd and 3rd digits are bilaterally frayed, irregular, and lace-like.
Radial
Pancreatic lithiasis
Radiographic examination of the lumbopelvic spine reveals numerous calcifications overlying the L1 and L2 vertebrae with extension to the left upper quadrant. In a patient with a history of chronic high alcohol intake, this most likely represents _________.
Anterior neck
Radiographic shadows within the upper mediastinum with borders that become lost above the level of the clavicle indicate a lesion located within the _________.
What is the key radiographic feature of Kummell's Disease?
Radiolucent cleft within the vertebral body
Hindfoot
Region of the foot: Calcaneus and Talus
Forefoot
Region of the foot: Metatarsal and Phalanges
Midfoot
Region of the foot: Navicular, Cuboid, and cuneiforms
A child presents to your office complaining of muscle spasm, irritability, and weakness. He lives in a pirating village in a third world country, as evidenced by the bandolier around his torso and the cigar in his mouth. The kid orders you to take an x-ray and licks the knife in his hand as a power move. Unequipped to fight the threat of child pirates, you take an x-ray and notice large uncalcified cartilage masses in his growth plates. What is the most likely cause?
Rickets
Name the radiographic sign: The peripheral margin of the epiphysis appears dense, whearas the central portion is more radiolucent. Seen in scurvy.
Ring epiphysis (Wimberger's Sign) Fig 14-27 Pg. 1517
Type 1 (Os tibiale Externum)
Round to oval, has smooth margins, and is widely separated from the navicular. It is a sesamoid bone in the posterior tibial tendon and rarely has clinical significance
What infectious agent most commonly affects patients with sickle cell?
Salmonella
All terms provided are associated with the image
Select all terms that are applicable regarding the image provided.
Medial Patellofemoral Joint Space
Shorter and more vertical than lateral in the knee
The combined findings of spinal osteoporosis and evidence of infarction (sclerosis, deformity, osteochondrosis) most likely make the diagnosis of what?
Sickle cell anemia
What is the most common cause of primary hyperparathyroidism?
Single adenoma (90%)
What imaging modality would you use to monitor the progression of hemophiliac pseudo-tumors?
Sonography
A 45 year old male presents to your office complaining of hip pain. Upon radiographic examination you notice increased density in the superior aspect of the femoral head, along with a radiolucent line beneath the superior cortex and a step defect on the superolateral cortex. There is also periosteal buttressing of the medial cortex. What is the most likely pathology?
Spontaneous osteonecrosis of the femoral head in adults
How does an acute bone infarction appear on T1 and T2 MRI images?
T1 = Reduced signal intensity T2 = Increased signal intensity
How do hemophiliac pseudo-tumors in soft tissue appear on T1 and T2 weighted images?
T1 and T2 - Low to heterogenous signal intensity
Cooley's anemia is another name for what?
Thalassemia
Honeycomb trabecular pattern is seen in which pathology?
Thalassemia
Left
The _________ hilum is 1-3cm more cephalic.
Concreations
The abdominal calcification(s) marked by the white arrows are characterized as _________.
Haustra
The air-filled large bowel is easily recognized on radiographs by the presence of semilunar mucosal folds, also known as _________.
Air bronchogram
The appearance of lucent tubes traversing a region of lung consolidation is known as an _________ sign.
Azygous fissure
The arrows represent?
It has four layers of pleura invaginated into the lung parenchyma.
The azygous fissure is not the most common accessory fissure. Although it is the most common visualized on PA chest because?
Ultrasonography
The diagnostic imaging procedures of choice in a patient with right upper quadrant pain referred to the inferior scapula is _________.
Coarctation of the aorta
The figure 3 sign is associated with which one of the following conditions?
Normal Skinners Line
The fovea capitus should lie at or above the level to the second line fracture and conditions leading to coxa var
FLAP
The greater tuberosity of the humerus may be avulsed by connecting tendons or fractured by direct trauma. It is frequently fractured during anterior humeral dislocation. This fracture is frequently referred to as which of the following?
Normal Shenton's Line
The line should be smooth and continuous hip dislocation, femoral neck fracture, and slipped femoral capital epiphysis
Kerley B lines
The linear densities noted at the lateral margins of the lower lunge are known as ________.
RUL (right upper lobe) RML (right middle lobe)
The minor fissure separates?
Hallux Sesamoids
The most common variation of the hallux, is separated into two (bipartite) or more (multipartite) segments, which may occur in up to 33% of cases
Type 2 (Oc Tibiale Externum)
The most common variety. It is triangular with a flat surface abutting the navicular and an intervening cleft of 1-2 mm filled with cartilage. This is the most common symptomatic variant, owing to injury of the synchondrosis. It is best confirmed by increased uptake on bone scan or local edema noted on MRI.
Posterior costophrenic angle
The most gravity dependent aspect of the lungs during a PA standing chest rejection is the ________.
distal tufts
The rounded tips of the distal phalanges, also called ungual tufts. should be uniform, lysis of these is associated with scleroderma as well as other arthritic and endocrine disorders
Middle lobe
The triangular shaped density noted on the lateral chest radiograph represents the right _________.
Interstitial
The two major general categories of parenchymal disease of the lung are air-space and ________ patterns.
Asbestos
This extensive mesothelioma, seen in the case provided, wraps around the patients left lung. What substance was he potentially exposed to that is highly associated with the development of a mesothelioma?
triphalangeal thumb
Thumb with 3 phalanges
A crescent sign is a radiolucent subchondral fracture paralleling the articular surface. True or false?
True
Bone necrosis for radiation can appear as moth eaten destruction. True or false?
True
Hair on end sign in the skull occur in thalassemia. True or false?
True
The pubis is a common site for insufficiency fractures associated with senile and postmenopausal osteoporosis. True or false?
True
Diabetes Mellitus
Vas deferens calcification is seen in patients with _________?
Name the radiographic sign: Increase in the width of the medial joint cavity, with an accompanying lateral displacement of the femur. Seen in Legg-Calve-Perthes Disease.
Waldenstrom's sign
Conduit wall
What abdominal calcification pattern is present (noted by the arrows)?
Conduit wall
What abdominal calcification pattern is present?
Cyst wall
What abdominal calcification pattern is present?
Mass
What abdominal calcification pattern is present?
5
What boyden segment is this condition located?
Coarctation of the aorta
What condition can be seen on the image provided?
Extrapleural sign (lesion is outside the lung)
What does this sign tell us?
Tracheal deviation
What finding suggests the cause of the lung opacification seen on this film?
40%
What is the approximate percentage of stones in nephrolithiasis that are opaque enough to be seen on plain film radiographs?
1:2
What is the normal cardiothoracic ratio?
9 mm (6-11 mm)
What is the teardrop average measurement
Anterior
What mediastinal division is this disease process located?
Solitary pulmonary nodule/mass
What radiographic pattern of disease is evident?
Extrapleural sign
What sign seen on this film indicates the lesion's location?
Interstitial
When looking at this CT of the chest make sure to evaluate which piece of anatomy is accentuated, therefore, which pattern does this represent?
A ratio of 1:2 heart to chest diameter
When the exposure is taken properly (PA, little to no rotation, and at 72 FFD/SID) how is the heart size evaluated?
Right upper lobe
Where is the azygous fissure usually found?
Kidney Retroperitoneal
Where is the calcification most likely located? (pick all that apply)
Mass in the lung
Where is the lesion?
Inferior scapula
Where may the gallbladder refer musculoskeletal pain?
Concretions
Which abdominal calcification pattern is present?
Hyperinflation (increases air-space)
Which is present?
Splenomegaly Avascular necrosis of the right femoral head
Which is present? (choose all that apply)
Diffuse interstitial disease
Which of the following best characterizes the radiographic pattern of lung disease?
Mediastinal lymphadenopathy
Which of the following chest diseases would be best assessed with magnetic resonance imaging, as opposed to computed tomography?
Helicobacter pylori
Which of the following infectious organisms is associated with development of peptic ulcer disease?
Lung contusion Lung laceration Hemothorax Pneumothorax
Which of the following is a potential complication with rib fractures?
Hiatal hernia
Which of the following is associated with a superiorly displaced gastric air bubble?
Trachea shifted towards the lesion Elevated diaphragm on the affected side Heart deviated toward the lesion
Which of the following is associated with atelectasis?
Ranke Complex
Which of the following is most applicable?
Sarcoidosis
Which of the following is most applicable?
Gallbladder
Which of the following is not a retroperitoneal structure?
40-inch focal film distance
Which of the following is not a typical part of the technical protocol of chest radiography?
Enlarged hilum
Which of the following is the most accurate finding for this patient?
Inferior
Which of the following is the most common accessory lung fissure?
Companion shadow
Which of the following is the most likely explanation for a linear density paralleling the superior margin of the clavicle on PA chest radiographic examination?
Diagnostic ultrasound
Which of the following is the procedure of choice for determining the presence, size, and extent of abdominal aortic aneurysm?
Interstitial
Which of the following patterns of lung disease most closely correlates to the appearance of fine radiodense linear shadows scattered throughout regions of the lung fields?
Upright PA chest
Which of the following radiographic views is most likely to confirm pneumoperitoneum?
Consolidation
Which pattern is present here?
Interstitial
Which pattern is present here?
Mass
Which pattern is present here?
Micro mass
Which pattern is present here?
Micro-mass
Which pattern is present here?
Airway
Which pattern of lung disease is seen int he image provided?
Consolidation
Which radiographic pattern of disease is evident?
Mass calcification
Which radiographic pattern of disease is evident?
Silhouette
Which radiographic sign accounts for part non-visualization of the right heart border on the PA radiograph?
Reticular
Which term does not describe the presence of water-based pathology (i.e. blood, edema, cells, protein, pus) within the alveolar sacs of the lung parenchyma?
Reduce the object to film distance Reduce penumbra Reduce magnification
Why should the lateral chest be taken with the left side closets to the film whenever possible?
Vascular Channels
Y and/or V-shaped grooves appearing as radiolucency's in the iliac fossa
styloid process
a ____________ is located at the base of the second metacarpal on its ulnar side which articulations with the trapezoid, capitate, and third metacarpal in a lock and key configuration
apophysis
a bony outgrowth or projection that lacks an independent center of ossification. usually a site for the attachment of ligaments and tendons .
sprengel deformity
a congenitally high position of the scapula -the scapula remains in its original embryonal position, not following its normal descent -this anomaly occurs unilaterally or bilaterally
syndactyly
a defect of mesenchymal organization during the 5th fetal week, resulting in any degree of webbing or fusion of the fingers or toes. may be demonstrated by soft tissue fusion between fingers and any osseous anomalies of development. more common in males, common developmental anomaly of the hand
brachymetacarpy
a disproportionate shortening of singular or multiple metacarpals
epiphysis
a part of a long bone developed from a center of ossification distinct from that of the shaft and separated at first from the shaft by a layer of cartilage
pie sign
a rotational abnormality, a triangular shape of the lunate with overlap of the capitate seen on the PA view following *lunate dislocation*
bayonette appearance
a wrist deformity may result from posterior subluxation of the ulna
Phleboliths
a. *Small round densities within the pelvic basin*, usually having a lucent center b. *Represent calcified thrombi* in the walls of the pelvic veins. c. Usually located below the level of the ischial spines d. Common after 30 years old. e. Incidental and not pathologic
Acetabular Notch
a. A break in the acetabular surface (rim) seen superomedially. b. Thought to be made by the attachment of ligamentum teres
Skinners Line
a. A line is drawn through and parallel to the femoral shaft b. A second line is drawn perpendicular to the first, through the proximal aspect of the greater trochanter
Ludloff's Spot
a. A lucency in the Distal Femoral epiphysis b. Triangle of Ludloff's patch c. Most pronounced in adolescents around 16yoa
Hallux Rigidus
a. A stiff painful 1st metatarsophalangeal joint b. Caused by trauma, but more commonly improper footwear
Standard Ankle Series
a. AP Ankle b. Medial Oblique Ankle (Mortise View) c. Lateral Ankle
Standard Hip series
a. AP Pelvis b. Frog Leg Lateral Projection
Standard foot series
a. AP foot b. Medial Oblique foot c. Lateral foot
Standard Knee series
a. AP knee b. Lateral knee c. Tunnel knee
Os intermetatarsum
a. An accessory ossicle located between the proximal first and second metatarsals occurs in about 3% of the population b. The majority are asymptomatic, but the anomaly may push the first metatarsal into varus and produce hallux valgus or fracture, cause dorsal foot pain, or create nerve compression
Morton's Syndrome
a. An anomalously short 1st metatarsal causes weight shift to 2nd metatarsal b. 2nd metatarsal may appear broader at its head than normal c. Patient may complain of localized foot pain at 2nd metatarsal head
Pellagrini-Stedia
a. Calcification of the medial collateral ligament b. Due to previous trauma to the knee
Blumensaat's line
a. Dense white line b. Represents the surface of the intercondylar notch
Paraglenoid Sulcus
a. Due to pressure from the superior gluteal artery b. Inverted "U" shaped defect may occur just lateral to inferior sacroliliac joint c. Most commonly seen in females d. May be uni or bilateral
"Patellar Tooth" sign
a. Enthesopathic degenerative change of anterior surface of Patella b. Degenerative changes c. Loss of patellofemoral joint space
Os trigonum
a. Failure of union of the secondary ossification center at the posterior aspect of the talus b. A triangular bony ossicle best depicted on lateral radiographs of the foot and ankle c. usually present by 7-14 years of age
Phalangeal synostosis
a. Fusion of the phalanges. b. Fusion of the 5th distal interphalangeal joint is very common. c. No clinical significance
Ishiopubic synchondrosis
a. Growth plates of the inferior pubic rami and ischium b. Fuse between 4 and 8 years of age c. May be present as an expansile region, disappears around 16 years of age. AKA - Van Neck's Disease
Accessory Views (ankle: stress views)
a. Inversion b. Eversion
female differences in pelvis
a. Larger pelvic basin b. Further apart and more horizontal inferior pubic rami
Hallux Valgus
a. Lateral deviation of the first phalanx with medial prominence of first metatarsophalangeal joint. b. May be congenital but usually acquired due to improper footwear.
Femoral Angle
a. Line drawn through the parallel to the femoral shaft b. Second line is drawn through the parallel to the femoral neck c. Result angle is measured d. To be accurate, foot should be medially rotated 15 degrees
Normal Klein's Line
a. Line should overlap the femoral head equally on both sides. b. Line may be drawn on frog-leg lateral projections & AP hip or AP pelvis asymmetry from side to side, then slippage of the femoral capital epiphysis should be suspected
Boehler's Angle
a. Measures on lateral foot (or lateral calcaneus) projections b. First Line connecting the anterior and middle tubercles of the calcaneus c. Second line is between the middle and posterior tubercles o Normal and is 28-40 degrees o Abnormal is less than 28 degrees o The most common cause for an angle < 28° is a fracture with displacement through the calcaneus
Heel pad thickness
a. Measures on lateral foot (or lateral calcaneus) projections b. Measure the distance between the inferior calcaneus and plantar skin c. Should measure not more than 25mm in men, 23mm in women d. Increased skin thickness, especially of the heel pad, is a frequent accompanying feature of *acromegaly*
Os Tibiale Externum
a. Medial to the navicular b. AP foot
Osgood-Schlater's Disease
a. More syndrome than a disease b. Most common in 11-15 yoa c. Localized tenderness and pain in region of tibial tuberosity d. Could be due to multiple growth around tibial tuberosity
Teardrop
a. Not a true anatomic structure b. Lateral border represents the anterior aspect of the acetabular fossa c. Medial border the quadrilateral surface of the innominate bone d. Average is 9mm (6-11mm) e. If the teardrop distance exceeds 11 mm or if there is more than a 2-mm discrepancy from right to left (Waldenstrom's sign), then hip disease is most likely present
Pubic Ears
a. Osseous projections arising from the superior pubic rami into the region of the obturator foramen b. No clinical significance
Os acetabuli
a. Ossicle at the *superolateral margin* of the acetabular roof. b. Most do not represent persistent marginal epiphysis. c. Associated Femoralacetabular impingement syndrome
Hypoplastic and Absent Patella (agenesis)
a. Ossification does not start until 4yoa b. Fong's Syndrome c. Absence of patella after 4yoa d. Missing radial head e. Ugly nails Also called • Nail patella syndrome • Hood's • Bilateral-Iliac horn syndrome
Bipartite Patella
a. Patella consists of two pieces b. Ossification centers within the patella do not to unite with maturity c. Located at the superolateral aspect of the patella d. Found bilaterally 80% of the time
Os Fabella
a. Round sesamoid bone located within the tendon of the lateral head of the gastrocnemius muscle b. No clinical significance c. More common in males d. Usually seen after 15yoa e. bilateral in 2/3 -3/4 of individuals
Sinding-Larsen-Johannsen Syndrome
a. Similar to Osgood-Schlater's b. Occurs at the *inferior patellar pole*
Pitt pit
a. Synovial herniation pit b. found in anterosuperior femoral neck as a ring-like, cystic lesion
Accessory views (knee)
a. Tangential Patella (Sunrise Patella) (Used to delineate the medial and lateral patellofemoral joint spaces0 b. Bilateral AP weightbearing knees c. Oblique Knee
PA medial oblique wrist
alignment of 1st metacarpal-trapezium is best visualized on this projection. *trapezium - trapezoid joint space is better visualized*
2mm
all carpal joint interspaces should not exceed? (scapho-lunate ligament most popular one)
jones projection
allows better visualization of the joint space between the trochlea and the olecranon process. the ulnar groove is also seen. this view is helpful in detecting intraarticular loose bodies and degenerative changes
supraclavicular foramen
allows passage of the medial branch of the supraclavicular nerve
Os infrascapular
an accessory ossicle located at the inferior angle of the scapula
polydactyly
an increase in the number of fingers or toes. this anomaly is usually associated with other syndromes
vascular or nutrient canals
appears as a linear radiolucency. radiographically visualized nutrient canals of the hand should not be mistaken for fissures or thin fracture lines
physis
cartilaginous plate which separates the epiphysis and the metaphysis in the immature skeleton.
metaphysis
conical section of bone between the epiphysis and diaphysis of long bones. most metabolic activity in long bones occurs here
medullary bone
contained in the internal cavity of bone and contains bone marrow.
pseudotumor appearance
cystic appearance produced by the greater tuberosity
rhomboid fossa
developmental variation at the attachment site of the costoclavicular ligament
metacarpal sign
evaluated using the PA projection of the hand. A single line is drawn tangential to the fourth and fifth metacarpal heads
crescent sign
formed by the superimposition of the humeral head and the glenoid fossa. increased radiopacity. seen in external rotation
elbow joint effusion
if i have a posterior fat pad, it is almost always seen with an anterior sail sign, which tells me i have a?
*internal before Trochlea*
if you can see a trochlea ossification center then you should be able to see a internal ossification center
scaphoid fat stripe
in almost 90% of fractures of the radial compartment the __________ is displaced lateral or obliterated
lateral wrist
in what radiograph should the 3rd metacarpal, capitate, lunate and radius form a straight line?
Waldenstrom's sign
increase medial compartment (joint space) between the femur and acetabulum. *>2mm* discrepancy between left and right
PA medial oblique wrist
joint space between trapezium & trapezoid better visualized
anterior humeral line
line drawn tangential to anterior aspect of humerus on lateral view, past the elbow joint line should fall through the *middle one third of the capitulum* an abnormal line may suggest supracondylar fracture
pronator quadratus fat stripe
made by pronator quadratus fascial plane and visualized on the lateral projection of the wrist. It appears as a radiolucent line running parallel and anterior to the distal radius this line is displaced or obliterated with a following fracture to the distal fifth of the radius
anterior fat pad
may be seen as a small triangular radiolucency just anterior to the humerus on lateral view. this is not a sign of pathology unless displaced
struther's ligament
may extend from the supracondylar process to the medial epicondyle, and it is possible to compress nerves or vasculature resulting in clinical signs and symptoms
acromiohumeral space
measured between superior aspect of humeral head and the inferior aspect of the acromion process (best in external rotation)
internal epicondyle
most common of ossification centers to become fractures and avulse in elbow
ulnar variance
normally the ulna is 1-2 mm shorter than the radius
carpal angle
on a PA wrist, the first line is drawn tangent to the *proximal surface of the scaphoid and lunate.* the second line is drawn tangent to the *proximal surface of the lunate and triquetrum*
CRITOE
ossification centers of the elbow
capitulum
ossifies at year 1. The C in critoe.
external (lateral) epicondyle
ossifies at year 11. the E in critoe
radial head
ossifies at year 3. the R in critoe
internal (medial) epicondyle
ossifies at year 5. the I in critoe
trochlea
ossifies at year 7. the T in critoe
olecranon
ossifies at year 9. the O in critoe
medial oblique hand
palm of hand 45 degrees to film
lateral elbow
patients elbow is flexed 90 degrees with thumb pointed up (points radial tuberosity up)
medial oblique elbow
patients hand is pronated for what view
AP elbow
patients hand is supinated for what view
clinodactyly
radial or ulnar deviation of a distal phalanx, usually radial deviation of the 5th distal phalanx. *characteristic finding of trisomy 21 (down syndrome)*
madelung's deformity
retarded growth of medial portion of distal radial epiphysis resulting in asymmetric growth, ulnar slant visualized radiographically & is usually a bilateral finding.
Terry Thomas sign
scaphoid dislocation 2nd m/c
posterior fat pad
seen adjacent to the posterior aspect of distal humerus. when present, it is never normal and indicates nonspecific effusion of the elbow joint. it is usually with displacement of the anterior fat pad.
intertubercular groove
seen between two tuberosities on humerus
greater tuberosity
seen in profile at lateral aspect of proximal humerus on external rotation & seen over humerus on internal rotation
supinator fat stripe
seen on lateral elbow view, parallel to the ventral aspect of the proximal third of the radius. in majority of adults the plane lies within 1 cm of the ventral margins of the radius. will be blurred, obliterated or ventrally displaced following fracture to the radial head or neck
lesser tuberosity
seen over proximal humerus in external rotation and in profile over glenohumeral joint in internal rotation
diaphysis
shaft of the bone, main function is mechanical support and housing of the bone marrow
abnormal metacarpal sign
short fourth metacarpal. diagnosis - juvenile chronic arthritis, sickle cell anemia, trauma, turner's syndrome
supracondylar process
small exostosis of bone projecting from the anteromedial aspect of the distal humerus toward the elbow joint
cortical bone
strongest and most dense portion of the bone, forms an outer layer of bones and one of its major functions is to add strength and support to the osseous architecture
baby arm projection
taken with 90 degree arm abduction and external rotation of the humerus. The forearm points cephalad. this view gives a lateral projection of the humeral head
girls
the CRITOE ossification usually occurs earlier in girl or boys?
symphalangism
the absence of the interphalangeal joints with resultant fusion of the phalanges
norgaard's projection
the accessory view of the hand, also known as ball catcher's view. used to detect early radiographic changes in *rheumatoid arthritis*, before lab test are positive
10-15
the distal radial articular surface slopes ________ degrees volarly (to palm)
2mm
the distal radioulnar articulation should not exceed?
hamate, ulnar
the fifth metacarpal articulates with the _________ on its _________ side
trapezium
the first metacarpal articulates with the?
decreased acromioclavicular joint space
the following are significant of? -DJD (degenerative joint disease)
increased glenohumeral joint space
the following are significant of? -acromegaly -posterior humeral dislocation
decreased glenohumeral joint space
the following are significant of? -degenerative arthritis -calcium pyrophospate dihydrate crystal disease (CPPD) -post traumatic arthritis
increased acromiohumeral space
the following are significant of? -post-traumatic subluxation -dislocation -joint effusion -stroke -brachial plexus lesions
increased coracoclavicular space
the following are significant of? -trauma (sprain)
increased acromioclavicular joint space
the following are significant of? -trauma (sprain) -post-traumatic osteolysis -resorption in association with hyperparathyroidism -RA
decreased acromiohumeral space
the following are significant of? may indicate rotator cuff tear or degenerative tendinitis resulting in unopposed action of the deltoid, allowing superior subluxation of the humerus
radiocapitellar line
the following are the differential diagnosis of what line? -dislocation of the radial head -fracture of the capitulum
thumb series
the following projections are for what series? -*AP* -oblique -lateral
finger series
the following projections are for what series? -*PA* -oblique -lateral
hamate, radial
the fourth metacarpal articulates with the _________ on its _________ side
128-142
the normal range for the carpal angle should be ___________ degrees.
capitulum view
the patients elbow is placed in the lateral position. tube is tilted 45 degrees cephalad. this view throws the capitulum and radial head clear of the overlying ulna and allows visualization of otherwise obscure fractures of the two structures
ulnar notch
the radius articulates with the head of the ulna at the?
trapezoid
the second metacarpal articulates with the?
metacarpal index
the sum of the maximal lengths of the 2nd-5th metacarpals divided by the sum of their midpoint widths. Index is above normal range in arachnodactyly and below normal in Morquio's disease
capitate
the third metacarpal articulates with the?
normal metacarpal sign
the third metacarpal falls below (proximal) this line
periosteum
thick fibrous membrane covering the entire surface of a bone except its articular cartilage. allows for appositional bone growth
steinberg thumb sign
tip of the thumb protrudes through the clenched fist. Differentials include marfan's, homocystinuria, or normal variant
ac joint series
two exposures are performed, one weighted and one nonweighted. the series is also performed bilaterally, enabling comparison with the unaffected side
positive ulnar variance
ulna is longer than normal. this results in more load being placed on the ulna, rendering it predisposed to lunate-triquetral ligament damage
negative ulnar variance
ulna is shorter than normal. this results in greater stress upon the lunate, predisposing it to AVN (avascular necrosis = keinbock's disease)
PA wrist with ulnar deviation
ulnar flexion, this view will help rule out scaphoid fracture
y projection (lateral scapula)
used if you suspect problem with scapula. enables visualization of the scapula with no superimposition of the ribs, lung tissue, and acromion. View is useful for evaluation of suspected posterior glenohumeral joint dislocation. patient stands P-A and is rotated 45-60 degrees
lateral wrist
useful in determining the relationship of the carpal bones with the distal radius following trauma
radioulnar synostosis
usually an isolated anomaly. it presents as a bone fusion due to lack of longitudinal segmentation of proximal radius and ulna. can be fibrous or osseous. clinically this may limit or prevent supination and pronation of the forearm
grashey spot projection
view allows visualization of the glenohumeral joint with no overlap of structures. patients humeral head is positioned so that it is flat against the bucky (patient will be oblique to the bucky, approximately 35-45) and the patients arm is placed in external rotation
measurement require comparison with the unaffected side
what do the acromioclavicular joint space & coracoclavicular space measurements require?
lunate, anteriorly
what is the most common carpal bone to dislocate? what way does it dislocate? (pie sign)
FOOSH
what is the most common method of injury for any of the upper appendicular skeleton?
5mm
what is the normal difference from side to side in coracoclavicular space measurement? the measurement should be *no more* then this number
3-4mm
what is the normal measurement of the acromioclavicular joint space?
7-11mm
what is the normal measurement of the acromiohumeral space
4-5mm
what is the normal measurement of the glenohumeral joint space?
11-13mm
what is the normal range of coracoclavicular space measurments?
2-3mm
when measuring the acromioclavicular joint space, there should be no more then _______ difference from side to side
