1. General MSK Laurie Lomasney, MD Professor Department of Radiology

2. General MSK Disease Categories –Arthropathy –Infection –Congenital –Vascular –Tumor Locale –Axial –Appendicular

3. 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

4. General MSK Disease Categories –Arthropathy –Infection –Congenital –Vascular –Tumor

5. Arthropathy Characteristics –Bone density –Erosions –Alignment Distribution –Poly vs mono –Symmetric vs asymmetric –Peripheral small vs central large

6. Arthropathy Periartic demin Prox/Symmetric swelling Wrist/MCP erosions Palmar/Ulnar deviat Rheumatoid Arthritis

7. Arthropathy Preserved density Asymmetric swelling Prox + Distal asymm erosions Psoriasis

8. Arthropathy Osteoarthritis Variable density No erosions Eccentric joint narrow Marginal proliferation

9. Arthropathy Preserved density Debris Sclerosis Malalignment Charcot Arthropathy

10. General MSK Disease Categories –Arthropathy –Infection –Congenital –Vascular –Tumor

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

12. Infection Metaphyseal osteomyelitis

13. Infection DIP Pyarthrosis Hip Pyarthrosis

14. General MSK Disease Categories –Arthropathy –Infection –Congenital –Vascular –Tumor

15. Congenital Variable appearance Variable consequence –Incidental –Pathologic Always Sometimes –Unknown

16. Congenital Ossification neural groove

17. Congenital Os Acromiale

18. Congenital Os tibiale externum

19. Congenital = 80% Narrow Bony Canal

20. General MSK Disease Categories –Arthropathy –Infection –Congenital –Vascular –Tumor

21. Vascular (Avascular necrosis) Multiple etiologies –Steroid therapy –Collagen vascular disease –Post-traumatic Staged appearance –Sclerosis –Collapse –Secondary osteoarthritis

22. Avascular necrosis Lunate AVN

23. Avascular necrosis Femoral head AVN

24. General MSK Disease Categories –Arthropathy –Infection –Congenital –Vascular –Tumor

25. Tumor Etiologies – Multiple Distribution – Specific to process –Axial vs appendicular –Monostotic vs polyostotic –Medullary vs eccentric –Child vs Adult

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

27. Tumor Non-ossifying fibroma

28. Tumor Giant cell tumor

29. Tumor Enchondroma

30. Tumor Chondrosarcoma

31. Tumor Osteogenic sarcoma

32. Tumor Osteosarcoma Gross pathology

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

34. You know you’re 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.

36. Thank you Laurie Lomasney, MD