SKELETAL PATHOLOGY

• Butterfly vertebra


  A congenital defect of a vertebra that produces the radiographic appearance of a butterfly on an AP projection
• Cervical rib


  A supernumerary or extra rib that is attached to C7
• Butterfly Vertebra


  • Most are of no significance but they do have the potential for causing instability or altering the shape of the spinal canal
• Butterfly Vertebra

  • This is a congenital defect that usually has no clinical significance
• Butterfly Vertebra


  • This is a lateral position of the previous patient demonstrating the radiographic appearance of a butterfly vertebra
• Cervical Rib

  • It is a poorly developed or rudimentary rib that is present in approximately 0.05% of the population
  • It is usually unilateral but in some cases, they can be bilateral
  • The concern with a cervical rib is that it may compress the brachial nerve plexus or the subclavian artery and thus require surgical removal
• Cervical Rib


  • The arrows on this image are pointing to a rudimentary rib that is attached to C7
• Osgood-Schlatter Disease

  A condition where the tibial tuberosity becomes inflamed following exercise
• Osgood-Schlatter Disease


  • It is one of the most common causes of knee pain in young athletes
  • It mainly affects boys ages 10 to 16
  • Treatment primarily consists of rest
• Osteogenesis Imperfecta (OI)

  A relatively rare congenital bone disorder that is characterized by bones that easily break
• Osteogenesis Imperfecta (OI)

  • People with this OI are born with insufficient amounts of a protein called type I collagen which plays an important role in bone formation
  • This collagen deficiency will result in osteopenia which is a decrease in the number of osteocytes
  • The net result is the formation of fragile or severely deformed bones
• Osteogenesis Imperfecta (OI)


  • The severe bowing that has occurred in this patient's humerus and forearm are an indication that the patient is suffering from a condition known as osteogenesis imperfecta
• Osteogenesis Imperfecta (OI)


  • The severe bowing that has occurred in this infant's tibia is an indication that the patient is suffering from a condition known as osteogenesis imperfecta
• Osteopetrosis


  A disorder of endochondral ossification that results in bones that are very hard and dense
• Osteopetrosis


  • Patients with this very rare condition possess bones that are very hard and dense
  • Oddly enough, their bones tend to be more brittle than normal
  • It can be fatal at birth or asymptomatic into adulthood
  • There is currently no definitive treatment for osteopetrosis
• Adult Osteopetrosis

  • The marbled radiographic appearance on these images is an indication that this patient has a condition known as adult osteopetrosis. This is the benign form of the disease
• Infantile Osteopetrosis


  • The marbled radiographic appearance on these images is an indication that this child has a the lethal form of infantile osteopetrosis
• Infantile Osteopetrosis

  • This is another example of the lethal form of infantile osteopetrosis
• Osteoporosis


  A disease characterized by a reduction in bone mass that makes patients with this condition susceptible to fracture formation
• Osteoporosis


  • The underlying mechanism in all cases is an imbalance between the body's normal process of bone destruction followed by bone growth
  • The primary causes are aging and postmenopausal hormone changes
  • Other causes include steroid use, osteogenesis imperfecta, multiple myeloma, and inactivity
• Osteoporosis

  • Patients with this condition are prone to hip fractures, compression fractures of the vertebral bodies, and Colles' fractures of the wrist
  • A common method to diagnose this condition is by the use of a dual energy X-ray absorptiometry (DEXA) scan
• Osteoporosis

  • The "washed-out" radiographic appearance of these images is the result of a loss of bone density and is an indication that the patient has a condition known as osteoporosis
• Osteomalacia


  A disease characterized by a softening of bones that results from insufficient mineralization
• Osteomalacia


  • It can cause a "bowing" of bones or lead to greenstick fractures
  • It can be caused by a decrease in absorption of either vitamin D or calcium
  • It can also be manifested in children who ingest an insufficient amount of vitamin D or who are not exposed to enough sunlight
• Osteomyelitis


  A bacterial bone infection that causes bone destruction and abscess formation
• Osteomyelitis


  • One characteristic is the formation of a Brodie's abscess
  • Another characteristic is a sequestrum formation, which is an avascular "island" of bone that forms within an abscess
  • It is usually treated with prolonged antibiotic therapy
• Rheumatoid Arthritis (RA)


  A type of arthritis that can involve joints, muscles, tendons, ligaments, and blood vessels
• Rheumatoid Arthritis (RA)


  • It begins as a chronic inflammation of synovial membranes that line joints
  • Thickened tissue (pannus) forms as a result of the inflammation and this causes erosion of the articular cartilage
  • Fibrous scaring occurs followed by ankylosis or "freezing" of the affected joint
  • The net result is a crippling deformity which begins in the extremities and progresses toward the trunk
• Rheumatoid Arthritis (RA)


  • It affects women three times more often than men
  • Signs and symptoms include morning stiffness, pain, and ulnar deviation of the fingers
  • Treatment includes steroids to reduce the inflammation and analgesics (aspirin) for pain
• Rheumatoid Arthritis (RA)


  • The radiographic appearance demonstrates how this crippling deformity results in ulnar deviation of the fingers
  • This patient had rods surgically inserted to help stabilize their neck from the debilitating effects of rheumatoid arthritis
• Ankylosing Spondylitis


  A chronic, degenerative arthritis that usually begins in the sacroiliac (SI) joints and spreads to the spine
• Ankylosing Spondylitis


  • It is characterized by osteoporosis and fusion of the SI joints and vertebral bodies
  • Due to its very distinctive radiographic appearance, it is commonly referred to as "bamboo spine" disease
  • Treatment includes steroids to reduce the inflammation and analgesics (aspirin) for pain
• Gout


  A disorder of purine metabolism that results in an increase in uric acid production
• Gout


  • The excess uric acid is deposited in the blood, kidneys, and joints
  • Joint deposits form as crystals that cause a very painful inflammatory reaction
  • Gout is primarily manifested in the feet (great toe) but it can also affect other areas such as the hands and knees
• Gout


  • Uric acid is deposited within the metatarsophalangeal joint space of the great toe
  • Gout can also affect the hands as indicated by the inflammatory reaction of the joints
• Osteoarthritis


  The most common degenerative joint disease
• Osteoarthritis


  • It is characterized by a natural loss of joint cartilage that is related to but not caused by aging
  • The body replaces this loss of cartilage with the formation of new bone in the form of spurs
  • These bone spurs cause the painful inflammation that is associated with this condition
  • Signs and symptoms include joint stiffness and pain that increases with activity
• Osteoarthritis


  • It is also affected by the weather and obesity
  • Treatment includes steroids to reduce the inflammation, analgesics (aspirin) for pain, and joint replacement surgery (total hip replacements)
• Paget's Disease


  Also known as osteitis deformans, it is characterized by an abnormal cycle or process of bone destruction followed by excessive bone growth and thickening
• Paget's Disease


  • It is commonly seen in the pelvis, lumbar spine, and skull
  • Signs and symptoms include bone pain, deformity, arthritis, and fractures