Radiopaedia Blog

3rd Oct 2013 03:44 UTC

Periosteal reactions

  1. Lamellated, layered or onion skin
  2. Codman triangle
  3. Solid
    • Indicative of a slow, benign processes, a solid periosteal reaction is characteristically seen with osteoid osteoma (my favorite tumor) and stress fracture, but may be a feature of many other osseous pathologies. 
  4. Spiculated, sunburst or hair on end
    • This periosteal reaction indicates a rapidly progressive underlying pathology, and is characeristic of Ewing sarcoma (and PNET), osteosarcoma, and a variety of metastatic lesions. 
General consideration

Although periosteal reactions may be seen in young and adult populations, the relatively loose attachment and active physiology of the periosteum in children leads to an earlier and more robust reaction to underlying pathology, and is a more sensitive indicator of disease. Lack of a periosteal reaction in adults, who have a tightly adhered and relatively inactive periosteum, is not unusual, even with highly aggressive underlying pathologies. (see the example of adult primary osteosarcoma at the bottom of this post) 

Diagram

 

Primary osteosarcoma in an adult male. Note the absence of a periosteal reaction. 

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Licked candy stick appearance

The term licked candy stick appearance refers to tapering of the tips of the metacarpal / tarsal bones, phalanges or clavicles. This finding can be seen in advanced cases of:

Psoriatic arthritis: enthesitis and marginal erosions destroy the peripery of the bone, leaving a thinned central region. This also leads to the "pencil in cup deformity". 

Rheumatoid arthritis: marginal erosions and destruction of the joint, due to destructive pannus, also may leave a tapered portion of bone.

Leprosy: atrophy and resorption of bone due to deinvervation, begins distally in the colder regions of the body and progresses proximally. 

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Section Editor Applications OpenIt's that time of year again and applications are open for the section editor 2014 positions.

Section editors are the guiding hand behind the collaborative effort of creating the largest online radiology resource on the web. As a section editor, you shape your section and maintain a high standard of content.

Being a section editor can take as little as 1 to 2 hours a week, and looks great on your CV. Your name will remain listed in the previous editors section, so that your contribution will be remembered.

  • duration: ideally 12 months
  • eligibility
    • accredited radiology registrar/resident or above
    • active member - the number and quality of prior contributions are a factor in selecting section editors (they also help you become familiar with the structure and workings of the site)
  • role
    • maintaining and organising your section 
    • reviewing new additions for links and content
    • contributing new articles and improvements of existing articles
    • participating in discussions with other editors with regard to site-wide issues
    • encouraging and providing feedback to new contributors as well as moderating new case and article contributions
    • actively promoting Radiopaedia.org

Being a section editor is rewarding, is a great way to study / revise and makes a noticeable addition to your CV. You also make connections with contemporaries from around the world, which, as many of the current editors will attest to, is one of the most enjoyable aspects of this community.

To apply, email a copy of your CV and a list of the sections you are interested in editing to jeremy@radiopaedia.org. Please include your Radiopaedia.org username, so that we can review your profile and previous contributions.

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27th Sep 2013 21:48 UTC

CAVITY - mnemonic

CAVITY - a useful mnemonic for the causes of a cavitating lung mass.

C = cancer 
A = autoimmune granulomas
V = vascular 
I = infection
T = trauma
Y = youth 

Case 1 is an example of a cavitating primary lung cancer. Case 2 shows a thick walled cavity in a patient with Wegener's granulomatosis. Case 3 is an example of tuberculosis. Case 4 is of congenital pulmonary airways malformation (CPAM) in a neonate. 

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24th Sep 2013 10:58 UTC

Radiology Quiz #2

What is this sign called, and what treatment of what condition causes it?

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