Bones

1.1 GENERALIZED INCREASED BONE DENSITY IN AN ADULT

Most common
1. Metastases; 2. Sickle cell disease; 3. Myelofibrosis.
Less common
4. Renal osteodystrophy; 5. Osteopetrosis; 6. Paget’s disease; 7. Systemic mastocytosis
Rare
8. Fluorosis; 9. Pyknodysostosis; 10. Hypoparathyroidism; 11. Progressive diaphyseal dysplasia (Camurati-Engelmann
disease; I2. Myeloma—rare osteosclerosing form. Associated with POEMS
syndrome.
1.2 SOLITARY SCLEROTIC some LESION
Most common
1.Bone island (enostosis); 2. Enchondroma; 3.Metastasis; 4.Callus; 5.Bone infarct
Less common
6. Paget’s disease; 7. Osteoma;.8. Osteoid osteoma/osteoblastoma;9. Healed or healing bone lesion; 10. Primary bone
sarcoma; 11. . Fibrous dysplasia; 12. Chronic osteomyelitis; 13. Chronic recurrent multifocal osteomyelitis (CRMO); 14..
Lymphoma; 15. Cement and bone graft substitutes
1.3 MULTIPLE SCLEROTIC BONE LESIONS
Most common
1.. Metastase; 2. Multiple healed bone lesions; 3. Paget’s disease;
Less common
4. Multiple bone infarcts; 5. Multiple stress fractures; 6. Lymphoma; 7. 0steopoikilosis; 8. Multifocal osteosarcoma.9.
Multiple osteomas;‘I0. Fibrous dysplasia; 11. CRMO and SAPHO.
Rare
12. Osteopathia striata (Voorhoeve disease); 13. Erdheim-Chester disease; 14. Multiple myeioma; 15.Tuberous sclerosis;
16. lntramedullary osteosclerosis
BONE SCLEROSIS WITH A PERIOSTEAL REACTION
Most common
1. Healing fracture; 2. Metastasis; 3. Osteoiosteoma/osteoblastoma; 4. Chronic osteomyelitis; 5. Osteosarcoma.
Less common
6. Ewing sarcoma; 7. Chondrosarcoma; 8. Lymphoma; 9. CRMO; 10. SAPHO syndrome,;11l. Infantile cortical hyperostosis
(Caffey’s disease)
Rare
12. Melorheostosis; 13. Tertiary syphilis;
1.5 SOLITARY SCLEROTIC BONE LESION WITH A LUCENT CENTRE
Most common
1. Osteoid osteoma osteoblastoma; 2. Brodie’s abscess.;3. Medullag bone infarct; 4. Stress fracture;
Less common
5. Looser’s zone of osteomalacia ; 6. Liposclerosing myxofibrous tumour; 7. Tuberculosis.
Rare
8. Syphilis. 9. Yaws.
1.6 COARSE TRABECULAR PATTERN
I. Paget’s disease.;2. Osteoporosis;3. Osteomalacia; 4. Haemoglobinopathies; 5. Haeman gioma; 6. Gaucher
disease.
1.7 SKELETAL METASTASES
Lytic
1 . Lung.
2. Breast;3. Myeloma. 4. Nonmucinous adenocarcinomas of the GI tract;5. Most other primary sources.
Lytic and expansile
1. Renal cell carcinoma;2. Thyroid;3. Hepatocellular carcinoma;4. Melanoma;5. Phaeochromocytoma.
Sclerotic
1. Prostate;2. Breast;3. Carcinoid;4. Mucinous adenocarcinomas of the GI tract; 5. Transitional cell carcinoma; 6. Small
cell lung cance; 7. Lymphoma.
Mixed
1 Breast; 2.Lung; 3.Lymphoma; 4.Cervix; 5.Testis; 6.Transitional cell carcinoma; 7.Melanoma.; 8.Neuroblastoma
1.10 LUCENT BONE LESIONS
Well-defined, sclerotic margin
1. Nonossifying fibroma;2. Bone cysts; 3. Fibrous dysplasia; 4. Chondroblastoma; 5. Brodie's abscess; 6. Healing
metastases or primary malignant bone lesions; 7. Osteoblastoma;; 8. lntraosseous lipoma; 9.Liposclerosing myxofibrous
tumour;10. Adamantinoma/osteofibrous dysplasia (OFD); 11.Chondromyxoid fibroma: 12. Haemophilic pseudotumour.
Well-defined, nonsclerotic margin:
1.Metastasis;2. Myeloma /plasmacytoma; 3. Low-grade chondral lesions; 4. Giant cell tumour; 5.Simple/ aneurysmaI
bone cyst; 6. Eosinophilic granuloma; 7. Brown tumour; 8. Lytic phase of Paget’s disease; 9. Desmoplastic fibroma;
Poorly defined margin
1. Metastasis;2. Myeloma; 3. OsteomyeIitis; 4. Bone lymphoma; 5. Primary bone sarcomas; 6.Eosinophilic granuloma; 7.
Giant cell tumour.
1.11 GROSSLY EXPANSILE LUCENT BONE LESION
Most common
1. Plasmacytoma; 2. Metastases—RCC; 3. Aneurysmal bone cyst; 4. Giant cell tumour;
Less Common
S. Telangiectatic osteosarcoma; 6. Fibrous dysplasia; 7. Brown tumour; 8. Haemangioma; 9. Chordoma
Rare
10. Haemophilic pseudotumour; 11. Slow growing central bone sarcoma.; 12. Hydatid cyst.
1.12 LUCENT EPIPHYSEAL BONE LESION
1.Lesions related to joint pathology; 2. Giant cell tum0ur; 3. Chondroblastoma; 4. |nfection; 5.Location-specific lesions;
6. Clear cell ch0ndrosarcoma; 7. Bone lesions which can occur anywhere
1.13 LUCENT BONE LESION CONTAININMG CALCIUM OR BONE
Most common
l. Enchondroma; 2. Osteoid osteoma and osteob|astoma; 3. Avascular necrosis and bone infarction.
4. Metastases;
Less common
S. Chondrob|astoma; 6. Chondrosarcoma; 7. Osteosarcoma.8. Fibrous dysplasia ; 9. Osteomyelitis with seguestrum; 10.
Eosinophilic granuloma; 11 Intraosseous lipoma; 12. Haemangioma; 13. Liposclerosing myxofibrous tumour 14.
Fibrosarcoma/undifferentiated pleomorphic sarcoma.
1.14 EXOPHYTIC AND IUXTACORTICAL BONE LESIONS
1.Callus; 2. Osteochondroma; 3. Heterotopic ossification and myositis ossificans; 4. Surface osteosarcoma—three types:
(a) Parosteal low grade (b) Periosteal intermediate grade (c) High grade; 5.Periosteal chondromalchondrosarcoma; 6.
Cortical desmoid; 7. Parosteal lipoma; 8. Bizarre parosteal osteochondromatous proliferation (BPOP); 9. Trevor's
disease: 10. Melorheostosis: I1. Osteoma; 12.Subperiosteal abscess; 13. Subperiosteal haemorrhage; 14. Periarticular
lesions ; 15. Other rare lesions not specific to this site.
1.15 MOTH-EATEN BONE’ IN AN ADULT
1. Metastases. 2. Multiple myeloma.3. Bone sarcoma; 4. Bone lymphoma; 5. Langerhans cell histiocytosis; 6.
Osteomyelitis . 7. Osteoporosis; 8. Hyperparathyroidism

1.16 REGIONAL OSTEOPENIA

Most common
1. Disuse; 2. Complex regional pain syndrome; 3. Inflammatory arthropathy; 4. Septic arthritis.
Less common
5. Transient osteoporosis of the hip. 6. Regional migratory osteoporosis; 7. Haemophilic arthropathy 8.Soft tissue
arteriovenous malformation.
1.17 GENERALIZED OSTEOPENIA
1. Osteoporosis.2. Diffuse infiltrative bone disease; 3. Osteomalacia/rickets; 4. Hyperparathyroidism.
1.18 OSTEOPOROSIS
1. increased radiolucency of bone; 2. Cortical thinning; 3. Prominent secondary trabeculae; 4. Vertebral fractures; 5.
Insufficiency fractures;
Causes
Primary
1. Postmenopausal.2. Age-related. 3. ]uvenile
Secondary
1.Endocrine 2. Disuse.3. latrogenic.4. Deficiency states, 5. Chronic and systemic disease; 6.Congenital

1.19 OSTEOMALACIA AND RICKETS

Most common causes
1. Vitamin D deficiency; 2. Renal disease (a) Glomerular disease; (b) Tubular disease; 3. Hepatic disease; 4.
Anticonvulsants; 5. Tumour-associated
Conditions which mimic rickets/osteomalacia
1. Hypophosphatasia. 2. Metaphyseal chondrodysplasia (Schmid type)
In infants <6 months of age
1. Biliary atresia. 2. Metabolic bone disease of prematurity; 3. Hypophosphatasia. 4. Vitamin D-dependent rickets;

Parallel spiculated (‘hair-on-end’)

1. Ewing sarcoma.2. Infantile cortical hyperostosis (Caffey’s disease). 3. Syphilis.
Divergent spiculated (’sunray’)
1. Osteosarcoma. 2. Metastases 3. Ewing sarcoma.4. Haemangioma.5. Meningioma. 6. Tuberculosis. 7.Tropical ulcer
Codman triangle (single lamina or lamellated)
1. A ressive mali nant bone tumour. 2. Osteomyelitis.
1.21 PERIOSTEAL REACTlONS—SOLlTARY AND LOCALIZED
1. Trauma; 2. Insufficienc and stress fractures 3. Inflammatory. 4. Neoplastic
1.22 PERIOSTEAL REACTlON—BlLATERALLY SYMMETRICAL IN ADULTS
1. Hypertrophic osteoarthropath HOA: 2. Vascular insufficiency; 3. Thyroid acropachy; 4.Pachydermoperiostosis; S.
Fluorosis, 6. Hypervitaminosis A.
1.24 ASYMMETRICAL PERIOSTEAL REACTlONS—BlLATERALLY
1 Metastases; 2.Osteomyelitis. 3. Reactive and psoriatic arthritis. 4. Nonaccidental injury; 5.Osteoporosis; 6.
Osteomalacia; 7. Bleeding diathesis. 8. Sickle cell dactylitis

1.24 HYPERTROPHIC OSTEOARTHROPATHY

Primary
Pachydermoperiostosis;
Secondary
Most common
1. Lung cancer; 2. Bronchiectasis; 3.. Lung metastases.
Less common
4. Other pleuropulmonary causes: 5. GI disorders: 6. Cyanotic congenital heart disease: 7. Cirrhosis and hepatobiliary
malignancies. 8. Other malignancies:
1.25 EXCESSIVE CALLUS FORMATION
Most common
1. Hypertrophlc fracture nonunion; 2. Neuropathic arthropathy; 3. Steroid therapy and Cushing’s syndrome.
Less common
4. Osteogenesis imperfecta; 5. Paralysis; 6. Renal osteodystrophy; 7. Multiple myeloma.
Children
8. Nonaccidental iniury.
1.26 OSTEONECROSIS/AVASCULAR NECROSIS
Common
1. Corticosteroids; 2. Alcohol. 3. Idiopathic 4. Fractures; 5. Chemotherapy.
Less common
6. Haemoglobinopathies 7. Radiotherapy; 8. Metabolic and endocrine; 9. Connective tissue diseases—10. Toxic; 11.
Haemopoietic disorders;.12. Thrombotic and embolic 13. Others
1.27 EROSIONS OF THE MEDIAL METAPHYSIS OF THE PROXIMAL HUMERUS
1 Normal variant.2. Chronic rotator cuff tear; 3. Hyperparathyroidism; 4. Rheumatoid arthritis. 5.Malignancy; 6.
Lysosomal storage disorders
1.28 EROSION OR ABSENCE OF THE OUTER END OF THE CLAVICLE
Common
1. Posttraumatic osteolysis 2. Postoperative; 3. Rheumatoid arthritis
Less Common
4. Malignancy; 5. Septic; 6. Hyperparathyroidism; 7.Cleidocranial dysplasia. 8. Pyknodysostosis 9.Scleroderma’ 10. Gout.
1.29 MADELUNG DEFORMITY
Primary
1.Short bowed distal radius with increased radiocarpal angle.2. Long dorsally subluxed ulna 3.V-shaped proximal carpal
row.
Secondary
The term secondary Madelung is often applied to similar bowing
1. Growth arrest following radial growth plate injgy or infection 2. Multiple hereditary exostoses. 3.Turner syndrome. 4.
Achondroplasia. 5. Leri-Weill dyschondrosteosis.
1.30 CARPAL FUSION
Congenital
Isolated
1. Lunate-triquetral. 2. Capitate-hamate. 3. Trapezium-trapezoid.
Syndrome-related
1. Acrocephalosyndactyly (Apert syndrome) 2. Arthrogryposis multiplex congenital; 3. Diastrophic dwarfism 4. Ellis-van
Creveld syndrome 5. Dyschondrosteosis 6. Hand-foot-genital syndrome; 7.Nievergelt syndrome; 8. Oto-palato-digital
syndrome; 9. Holt-Oram syndrome; 10. Turner syndrome; 11. Symphalangism; 12. Fetal alcohol syndrome
Acquired
1. Inflammatory arthritides; 2. Pyogenic arthritis. 3. Chronic tuberculous arthritis. 4. Posttraumatic. 5.Postsurgical.
1.31 SHORT METACARPAL(S) OR METATARSAL(S)
1. Idiopathic. 2. Posttraumatic; 3. Postinfarction; 4. Turner syndrome; 5. Pseudo and pseudopseudohypoparathyroidism
1.32 ARACHNODACTYLY
Most common
1. Marfan syndrome; 2. Normal variant
Less common
3. Homocystinuria. 4. Ehlers-Danlos syndrome. 5. Klinefelter syndrome. 6. Loeys-Dietz syndrome.
7. Congenital contractural arachnodactyly (Beals syndrome). 8. MEN 2B. 9. Myotonic dystrophy. 10.Stickler syndrome.
1.31 DISTAL PHALANGEAL DESTRUCTION
Resorption of the tuft (acroosteolysis)
Most common
1. Scleroderma; 2. Raynaud disease; 3. Psoriatic arthropathy; 4. Hyperparathyroidism; 5. Trauma
Less common
6. Peripheral neuropathy; 7. Other arthritides; 8. Other skin disorders; 9. Phenytoin toxicity; 10. Snake and scorpion
venom. 11. Pyknodysostosis
Resorption of the midportion
1. Hyperparathyroidism. 2. Polflinyl chloride tank cleaners. 3. Acroosteolysis of Haidu and Cheney
1.34 LYTIC LESIONS or THE PHALANGES
Poorly defined
1. Osteomyelitis: 2. Metastasis;
Well Defined
1.Enchondroma; 2. oint-based lesions; 3. Implantation epidermoid; 4. Glomus tumour 5. Sarcoidosis;
6. Other rare lesions not specific to the phaIanges.
1.35FLUlD—FLUlD LEVELS IN BONE LESIONS ON CT AND MRI
Benign
1. Aneurysmal bone cyst. 2. Chondroblastoma. 3. Giant cell tumour. 4. Simple bone cyst. 5.Fibrous dysplasia.
Malignant
1. Telangiectatic osteosarcoma. 2. Any necrotic bone tumour.