Osteonecrosis

Ichemia underlies all forms of bone necrosis, cortex not usually affected due to collateral blood flow, CREEPING SUBSTITUTION subcondral infarcts cause chronic pain associates w/ activity; medually infarcts are clinically silent except for large ones seen in Gaucher's, sickle cell

Osteomyelitis Pyogenic osteomyelitis

Inflammation of bone - vitually always implied infection caused by bacteria = staph a, e. coli, psuedomonas, klebsiella - infection resides in osseous vascular circulation actue systemic illness, fever, chills, etc. - radiographic finding of lytic focus of bone destruction surrounded by zone of sclerosis in children, subperiosteal abscesses may form that can track for long distance sequestrum - dead piece of bone draning sinus - rupture of the periosteum -> soft tissue abscess -> formation of draining sinus Involucrum - newly deposited bone forms sleeve of tissue around segment of devitalized infected bone brodie abscess - small intraosseus abscess, freq. involves the cortex, walled off by reactive bone

Sclerosing osteomyelitis of Garre Tuberculous Osteomyelitis Skeletal Syphilis

develops in the jaw, associated with extensive new bone formation that obscures much of the underlying osseous structure immunosuppressed people, pain on motion, localized tenderness, 1-3% of pulmomary or extrapulmonary infected people have osseus infection syphilis and yaws can both infect bone, syphilis is experiencing a resurgence, spirochetes at areas of active enchondral ossification spirochetes in inflam tissue with silver stain, "saber shin" is produced massive reactive perioisteal bone deposition

Osteoma Osteoid Osteoma Osteoblastoma Osteosarcoma

Gardeners Syndrome Severe nocturnal pain RELIEVED by aspirin, less than 2cm Dull achy pain NOT relieved by aspirin, greater than 2cm Malignant - most common primary malignant tumor of bone, codman's triangle, Li-Fraumeni syndrome (p53 mutation), 50% in knee Painful, progressively enlarging masses, can present with sudden fracture, can metastases to bones, brain and elsewhere

Osteochondroma Chondroma

Multiple hereditary exostosis syndrome, EXT1/2 gene mutations (loss of fx), most common benign bone tumor, MUSHROOM shaped Enchondromal origin, oval lunecies surronded by thin rim of radiodense bone "C" or "O" ring sign Ollier disease: multiple enchondromas or enchondromatosis Maffuci syndrome: soft-tissue hemangiomas -> can develop other malignancies

Chondroblastoma Chondromyxoid Fibroma

@ Knee, Epiphyses/Apophyses, CHICKEN WIRE pattern of mineralization, usually painful d/t location near joint, produce spotty calcifications rarest of cartilage tumors, metaphyses of long bones, can be mistaken for chondrosarcoma Localized dull achy pain, do not pose a threat for malignancy

Chondrosarcoma Fibrous Corticol Defect and Non-ossifying Fibroma Fibrous Dysplasia

Malignant - 2nd most common malignant matrix producing tumor of bone, age = 40s, rarely involve the distal extremities, painful/progressively enlarging masses, preferentially spread to the lungs and skeleton extremely common, defects rather than neoplasms. Size matters, large ones are non-ossifying and have a pinwheel or storiform pattern ground glass appearance; polystotic w/ caf-au-lait skin pigmentation McCune-Albright syndrome, coastline of maine, GNAS, trabeculae mimic chinese letters Endocrinopathies include: sexual precocity, hyperthyroidism, pituitary adenomas -> GH, and pituitary adrenal hyperplasia Monostotic disease causes minimal symptoms

Fibrosarcoma Ewing Sarcoma/PNET Giant Cell Tumor Aneurysmal Bone Cyst

herringbone-storiform pattern, enlarging and painful masses, poor prognosis, mostly pelvic flat bones Ewing: undifferentiated, PNET: neuronally differentiated; onionskin appearance, homer-wright rosettes Osteoclastoma, uncommon benign, express RANKL, giant osteoclast like cells form via the RANK-RANKL path BLUE BONE, benign, metaphyses of long bones and posterior elements of vertebral bodies, causes pain and swelling