Malignant Bone Tumors: Clinical Findings and Complications #Malignant #BoneTumors #Bony #Complications #pathophysiology

Malignant Bone Tumors: Pathogenesis of X-ray appearance • Metastatic bone tumors (aka. cancerous cells from systemic locations that metastasized to the bone) are 200 times more common than primary bone tumors. • Metastatic bone tumors can often look differently from primary bone tumors on X-ray, depending on the source of metastasis: • Breast. prostate cancer bone metastases are often "radio-dense" (sclerotic lesions that look whiter than normal bone) - these cancer cells activate osteoblasts more than osteoclasts. • Lung. thvroid. and renal cancer bone metastases are often "radio-lucent" (osteolytic lesions that look darker than normal bone) - these cancer cells activate largely osteoclasts. Signs/Symptoms: • "Interrupted periosteal reaction ' • "Moth-eaten", permeative bone destruction • Wide zone of transition between bone and tumor (Ill-defined border) • Soft-tissue mass accumulation around the bone tumor #BoneTumors #Malignant #Radiology #Diagnosis #XRay #Bony

Primary Bone Tumors - Differential Diagnosis Algorithm Metastatic - Most common tumour in adults - Breast - Prostate - Thyroid - Lung - Renal Primary Benign • Osteochondroma • Osteoid osteoma • Chondroblastoma • Friboxanthoma • Fibrous Dysplasia • Non-ossifying fibroma • Chondromyxoid Fibroma • Periosteal Chondroma Aggressive, Non-Malignant • Giant Cell Tumour • Enchondroma • Aneurysmal Bone Cyst Malignant - 66% of adult tumours • Multiple Myeloma- most common • Osteosarcoma • Chondrosarcoma • Ewing's Sarcoma • Fibrosarcoma • Liposarcoma • Rhabdomyosarcoma • Leiomyosarcoma • Malignant Fibrous Histiocytoma #Primary #Bone #Bony #Tumors #Tumours #MSK #Differential #Diagnosis #Algorithm #Orthopedics #Causes #Oncology #Radiology

Osteoarthritis (OA): Clinical findings • Stimulation of joint nociceptors in subchondral bone -> Pain with loading / use of joint • Disruption of normal joint architecture -> Palpable bony hypertrophy (ex. Bouchard's nodes) • Lack of cartilage means direct contact between bony processes with movement of the joint -> Crepitus • Impaction of osteophyte with normal joint structures during movement, Joint movement with reduced lubrication stimulates joint nociceptors -> Pain with motion, Decr range of motion • Dysregulation of proteolytic enzymes, joint fluid production -> Joint effusion #Osteoarthritis #OA #pathophysiology #diagnosis #signs #symptoms #complications

Humerus Bony Anatomy - Anterior and Posterior Views By @rev.med #Humerus #Bony #Anatomy #MSK #Bone

Diagram of different types of bone tumors that can occur around the knee on XRay - Age < 30 years • Fibrous Dysplasia • Osteochondroma: pedunculated, sessile, cauliflower • Enostosis/bone island • Osteomyelitis or other aggressive lesion • Simple/unicameral bone cyst • Aneurysmal bone cyst • Osteoid osteoma • Ewing sarcoma • Enchondroma • Chondroblastoma • Osteosarcoma • Non-ossifying fibroma Dr. Matt Skalski @docskalski #Knee #Bone #Tumors #Diagnosis #Bony #Differential #Radiology #XRay #peds #pediatrics #msk #lesions #adult

Bone Lesion on X-Ray - Differential Diagnosis Algorithm Exostotic • Osteochondroma Asymptomatic &/or Non-Active Bone Scam • Unicameral Bone Cysts • Aneurysmal Bone Cysts • Non-ossifying Fibroma Inflammatory Appearance • Osteoid Osteoma ("Nidus" appearance) • Osteoblastoma (may be malignant or sclerotic in appearance) Not Inflammatory Appearance • Chondroblastoma • Chondromyxoid Fibroma Multiple Lytic Lesions • Multiple Myeloma Benign - No Bone Mineralization • Enchondroma (can calcify &/or turn malignant) • Giant Cell Tumor ("Soap Bubble" appearance) Malignant - Bone Mineralization, Constitutional Symptoms, Codman's Triangle, Excessive Scalloping & Destruction of Cortical Bone • Osteosarcoma (Codman's Triangle) • Chondrosarcoma ("Popcorn" appearance) • Ewing's Sarcoma #Bony #Mass #Tumor #BoneLesion #XRay #MSK #Differential #Diagnosis #Algorithm #Orthopedics #Causes

Complications of Measles: Pathogenesis and Clinical Findings • ADEM -> Fever, headache, neck stiffness, BBD, mental status changes, sensory and motor changes • Myocarditis, Pericarditis • Pneumonia -> Cough, SOB, fatigue, fever, hypoxemia • Stomatitis -> Focal pain at site of oral ulcer • Hepatitis -> RUQ Pain, N/V, elevated liver enzymes • Immunosuppression -> Opportunistic infections #Measles #Complications #diagnosis #signs #symptoms #pathophysiology

Diagram of different types of bone tumors that can occur around the knee on XRay - Age > 30 years • Multiple Myeloma - punched out lesions. endostea/ scalloping • Healed NOF • Giant cell tumor • Chronic osteomyelitis - with sequestrum, cloaca, and involucrum • Paget disease - blastic or mixed lytic-blastic phase • Paget disease - lytic phase with flame/blade of grass sign • Parosteal Osteosarcoma • Aggressive lesion - lytic metastasis or osteomyelitis • Lymphoma or blastic metastatic lesion • Geode (AKA degenerative subchondral cyst, intraosseous ganglion) • Enostosis/bone island • Stress fracture • Chondrosarcoma • Stress fracture or intracortical Brodie abscess Dr. Matt Skalski @docskalski #Knee #Bone #Tumors #Diagnosis #Bony #Differential #Radiology #XRay #msk #lesions #adult

Anorexia Nervosa: Complications CARDIAC ABNORMALITIES - Functional: Low BP, Sinus bradycardia, prolonged QT interval - Structural: Reduced cardiac muscle mass GASTROINTESTINAL FINDINGS - Gastroparesis and Constipation - Elevated Hepatic Enzymes - From fasting/weight loss RENAL FINDINGS - Dehydration -> GFR leads to BUN -> Significant Hypotension/ Hypovolemia NEUROLOGIC FINDINGS - Cerebral Atrophy and Metabolic Encephalopathy from significant fluid and electrolyte disturbances -> Difficulty concentrating and memory loss HEMATOLOGIC FINDINGS - Leukopenia with lymphocytosis, mild anemia and thrombocytopenia ENDOCRINE ABNORMALITIES - Hypogonadotrophic hypogonadism - acquired from nutrient deficiency and hormone suppression - Low-Normal T3/T4 - Females: Low Serum Estrogen - Males: Low Serum Testosterone - Delay of puberty/menarche - Amenorrhea - (loss of menses) - Osteopenia/Osteoporosis - Low bone mineral density, Significantly increased risk of fracture DERMATOLOGIC PRESENTATIONS - Dry skin, brittle nails, hair loss, hypercarotenemia (yellowing of skin) - Lanugo: fine downy hair covering limbs and cheeks (to preserve warmth) GENERAL FEATURES: - Emaciation: loss of body fat and muscle - Hypothermia and Cold Intolerance - Lethargy or Excess Energy Death - Cardiac complications, starvation, electrolyte imbalance • Note: Anorexia nervosa has one of the highest mortality rates of all psychiatric illnesses • Suicide risk is increased in anorexia, especially the binge-purge subtype #AnorexiaNervosa #Complications #pathophysiology #diagnosis #signs #symptoms #psychiatry

Presentation of malignant disease in children Pre-school (<5 years old) - Acute lymphoblastic leukaemia - (ALL) - peak incidence - Non-Hodgkin lymphoma - Neuroblastoma - Wilm tumour - Retinoblastoma School-aged - Acute lymphoblastic leukaemia (ALL) - Brain tumours Adolescence - Acute lymphoblastic leukaemia (ALL) - Hodgkin lymphoma - Malignant bone tumours - Soft tissue sarcomas #Malignancy #Tumors #Cancer #Presentation #Malignant #Childhood #Peds #Pediatrics #Diagnosis