The differential for cartilagenous lesions includes:
The cases featured in these video lectures are specifically selected to teach important concepts in radiology over a broad range of topics. The tutorials vary in difficulty from basic to advanced. For maximum learning, try the cases for yourself in Radiopaedia quiz mode first.
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The Castellvi classification is used for lumbosacral transitional vertebra (LSTV):
type I: enlarged and dysplastic transverse (at least 19 mm)
type II: pseudoarticulation of the transverse process and sacrum with incomplete lumbarisation/sacralisation; enlargemen...
The Caton-Deschamps index is a ratio that is used in everyday practice as well as in research to measure patellar height and allows the diagnosis of patella alta and patella baja.
The Caton-Deschamps index is the ratio between the distance between the lower pole of the pa...
The Catterall classification is based on radiographic appearances of the epiphysis and metaphysis visible in osteonecrosis of the femoral head:
bone absorption changes visible in the anterior aspect of the epiphysis of femoral head
changes are visible best in frog leg lateral view
There are several important causes of an abnormal lunate signal on MRI, the most frequent causes being Kienbock disease (25%), ulnar impaction syndrome (25%) and intraosseous ganglia (20%).1 Appreciation of the pattern of bone signal change can often allow the correct diagnosis to be made.
A mnemonic for remembering the symmetric vs. asymmetric causes of sacroiliitis is:
P: psoriatic arthritis
A: ankylosing spondylitis
I: inflammatory bowel related
R: reactive (e.g. Reiter syndrome)
The outside letters P & R (letters are far apart) are the asymmetric causes an...
Cavernous venous malformation, also traditionally referred to as a cavernous haemangioma (despite it not being a tumour) or cavernomas, are non-neoplastic slow flow venous malformations found in many parts of the body.
Despite the ubiquity of use of the traditional terms cavernoma...
Celery stalk metaphysis refers to a plain film appearance of the metaphyses in a number of conditions characterised by longitudinally aligned linear bands of sclerosis. They are seen in:
congenital cytomegalovirus (CMV)
The celery stalk sign is a term given to the appearance of the anterior cruciate ligament which has undergone mucoid degeneration and has been likened to that of a celery stalk. Its low signal longitudinal fibres are separated from each other by higher signal mucinous material, best appreciated ...
Cellulitis (more specifically referred to as superficial cellulitis) is an acute infection of the dermis and subcutaneous tissues. It results in pain, erythema, oedema, and warmth. Since the epidermis is not involved, cellulitis is not transmitted by person-to-person contact.
Cenani-Lenz syndactyly (CLS) is a very syndrome primarily characterised by:
syndactyly/oligodactly: syndactyly is often complete and gives a spoon hand type appearance
It carries an autosomal recessive inheritance.
It was first described...
The central sacral vertical line (CSVL) is used in the assessment of spinal scoliosis.
It is a line constructed on frontal films of the spine and pelvis as follows:
a line connecting the top of the iliac crests is drawn
a second line is drawn perpendicular to the first, which bisects the sac...
Cerebrotendinous xanthomatosis is an autosomal recessive lipid storage disorder caused by defects in sterol-27-hydroxylase enzyme in bile acid synthesis. This leads to early cataract formation, atherosclerosis, hypercholesterolemia, and tendinous xanthomas.
Cervical canal stenosis can be acquired (e.g. trauma, discs, and ossification of the posterior longitudinal ligament) or congenital. It refers to narrowing of the spinal canal, nerve root canals, or intervertebral foramina of the cervical spine.
normal AP diameter is ~17 ...
Cervical degenerative changes can be graded using a very old but reliable classification given by Kellgren et al. It is based on findings on a lateral cervical spine radiograph although it can also be applied to MRI evaluation of spine.
The key parameters are osteophyte formation, intervertebra...
The cervical ligament attaches to the calcaneus and talus. It is lateral to the tarsal sinus and medial to the attachment of extensor digitorum brevis. It is taut in inversion.
Cervical rib is a supernumerary or accessory rib arising from the seventh cervical vertebra. They occur in ~0.5% of the population, and are more common in females.
Although cervical ribs are usually asymptomatic, they are the most important anatomic rib variant clinically, because they can caus...
The cervical spine is the upper part of the spine extending from the skull base to the thorax at the level of the first vertebra with a rib attached to it. It normally consists of seven vertebrae. Its main function is to support the skull and maintain the relative positions of the brain and spin...
A floating pillar, also referred as pedicolaminar fracture-separation injury, is characterised by fractures through the pedicle and lamina of a cervical spine vertebrae creating a free-floating articular pillar fragment. It is an unstable cervical spine fracture that results from hyperflexion–la...
There are several cervical spine fracture classification systems:
Anderson and D'Alonzo classification (odontoid fracture)
Roy-Camille classification (odontoid fracture)
Levine and Edwards classification (for traumatic injuries to axis)
Allen and Ferguson classification (subaxial spine injur...
Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading.
The cervical spine is susceptible to injury because it is highly mobile with relatively small vertebral bodies and supports the head which is both heavy and...
The closed mouth odontoid AP view (Fuchs view) is a nonangled AP radiograph of C1 and C2. This view focuses primarily on the odontoid process. The standard Fuchs view should not be used in a trauma setting and the modified Fuchs view may be used instead.
patient is supine or ...
Cervical spine injuries can involve the cervical vertebral column, intervertebral discs and cervical spine ligaments, and/or cervical spinal cord. The cervical spine accounts for ~50% of all spinal injuries.
5-10% of patients with blunt trauma have a cervical spine injury 1.
Cervical spine ligaments ordered from anterior to posterior include:
anterior longitudinal ligament (ALL)
anterior atlanto-occipital membrane
alar ligaments (paired)
cruciate ligament of the atlas
longitudinal band: joins the body of the axis to the foramen magnum
The term cervical stenosis can refer to:
stenosis of the uterine cervix
bony cervical canal stenosis (cervical spinal stenosis)
Chalk stick or carrot stick fractures are fractures of a fused spine, classically seen in ankylosing spondylitis.
Some authors define the chalk stick fracture as a fracture through a Pagetoid long bone (see Paget disease).
They usually occur through the disco-vertebral ...
Chamberlain line is a line joining the back of hard palate with the opisthion on a lateral view of the craniocervical junction.
It helps to recognise basilar invagination which is said to be present if the tip of the dens is >3 mm above this line.
McGregor developed a modificatio...
The champagne glass pelvis is a helpful sign in achondroplasia in which the iliac blades are flattened, giving rise to a pelvic inlet that resembles a champagne glass. The acetabular angles are flattened (horizontal) and the sacrosciatic notch is small.
Chance fractures, also referred as seatbelt fractures, are flexion-distraction type injuries of the spine that extend to involve all three spinal columns. These are unstable injuries and have a high association with intra-abdominal injuries.
They tend to occur from a flexi...
Charcot joint, also known as a neuropathic or neurotrophic joint, refers to a progressive degenerative/destructive joint disorder in patients with abnormal pain sensation and proprioception.
In modern Western societies by far the most common cause of Charcot joints is diabetes, an...
The causes of a Charcot joint can be remembered, with a little poetic license, as they (all) start with the letter S.
spinal cord injury
The features of Charcot arthropathy can be remembered...
Chauffeur fractures (also known as Hutchinson fractures or backfire fractures) are intra-articular fractures of the radial styloid process. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size.
These injuries are sustained eit...
The Chauveaux–Liet angle (CL angle) is represented by the difference between the angle of verticalization (α) and morphologic angle (β) of the calcaneus (CL angle = α − β).
Angle α is the calcaneal pitch angle or angle of verticalization of calcaneus described as the intersection of the baselin...
The Cheerio sign has been described as a sign seen in a type III superior labral anterior posterior tear (SLAP lesion) of the glenoid labrum. In the cheerio sign, a rounded core of soft tissue is surrounded by a rim of contrast material and gas.
SLAP type III is the bucket handle tear of the s...
Chest x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using A, B, C, D, E is a helpful and systematic method for chest x-ray review where D refers to disability and specifically fractures and dislocations.
This is a...
Chondroblastomas, also referred as Codman tumours, are rare benign cartilaginous neoplasms that characteristically arise in the epiphysis or apophysis of a long bone in young patients. Despite being rare, they are one of the most frequently encountered benign epiphyseal neoplasms in skeletally i...
Distinguishing between a chondroblastoma and an epiphyseal clear cell chondrosarcoma can be difficult. Helpful features which suggest a clear cell chondrosarcoma include:
older age (chondroblastomas tend to occur 10-20 years earlier)
absent adjacent bone oedema
high T2 signal (so...
Although frequently used as a synonym for calcium pyrophosphate dihydrate deposition disease (CPPD), chondrocalcinosis simply means visible calcification of both hyaline cartilage and fibrocartilage.
It has a reported prevalence of 5-15% 2 and is thought to increase with age.
Mnemonics for chondrocalcinosis include:
WHIP A DOG
C: crystals e.g. CPPD, sodium urate (gout)
C: cations e.g. calcium (any cause of hypercalcemia), copper, iron
C: cartilage degeneration (e.g. osteoarthritis, acromegaly, ochronosis)
WHIP A DOG
W: Wilson di...
Chondrodysplasia punctata (CDP) is a collective name for a heterogenous group of skeletal dysplasias. Calcific stippling of cartilage and peri-articular soft tissues is often a common feature.
It can be broadly divided into rhizomelic and non-rhizomelic forms:
Chondroectodermal dysplasia, also known as the Ellis-van Creveld syndrome, is a rare type of skeletal dysplasia. It is classified as a type of mesomelic limb shortening 5.
Clinical features include:
narrowing of thorax with short ribs
small and flared ilia
Chondroid lipomas are rare benign soft tissue tumours that, as you might guess, contain a varied ratio of both fat and cartilage. These lesions can be diagnostically confusing as they may mimic or be confused with other fat containing neoplasms, most importantly those of much greater clinical si...
Chondrolysis, also known as acute cartilage necrosis, is an acute cartilage destruction of the femoral head. It is one of the complications that are specifically associated with slipped capital femoral epiphysis (SCFE). It is a poorly understood phenomenon.
The quoted incidence is...
Chondromalacia can be divided into 4 grades by MRI, typically using fat saturated proton density sequences. This grading system is the modified Outerbridge grading system, which was devised for arthroscopy initially for assessment of chondromalacia patella, but then modified and extended for all...
Chondromalacia patellae refers to softening and degeneration of the articular hyaline cartilage of the patella and is a frequent cause of anterior knee pain.
Tends to occur in young adults. There is a recognised female predilection.
Patients with chondromal...
Chondromyxoid fibromas (CMFs) are extremely rare, benign cartilaginous neoplasms that account for <1% of all bone tumours.
The majority of cases occur in the second and third decades, with ~75% of cases occurring before the age of 30 years 1,12-15. There is no recognised gender ...
Chondrosarcomas are malignant cartilaginous tumours that account for ~25% of all primary malignant bone tumours. They are most commonly found in older patients within the long bones, and can arise de novo or secondary from an existing benign cartilaginous neoplasm. On imaging these tumours have ...
Chondrosarcoma grading allows the division of chondrosarcoma into 3 (sometimes 4) grades.
Grade 1 - low grade
mostly chondroid matrix
little if any myxoid
difficult to distinguish from enchondroma (see enchondroma vs. low grade chondrosarcoma for imaging distinguishing feat...
Chondrosarcomas of the base of the skull are rare compared with other skull base tumours but are an important differential diagnosis as surgical resection and management are affected by the preoperative diagnosis.
Chondrosarcomas of the base of the skull make up only a small fract...
Chopart fracture is a fracture/dislocation of the mid-tarsal joint (Chopart joint) of the foot, i.e. talonavicular and calcaneocuboid joints which separate the hindfoot from the midfoot. The commonly fractured bones are the calcaneus, cuboid and navicular.
The foot is usually dislocated mediall...
There are many signs in radiology that are related to Christmas:
snowcap sign in avascular necrosis
in total anomalous pulmonary venous return
in pituitary macroadenomas
snowstorm appearance in complete hydatidiform and testicular microlithiasis
holly leaf sign in calcified pl...
Chronic exertional compartment syndrome (CECS), previously known as anterior tibial syndrome, is a type of compartment syndrome that is brought on by exercise.
The exact prevalence is not known since sufferers may modify the way they exercise and therefore never present. CECS can ...
Chronic granulomatous disease (CGD) refers to heterogeneous group of inherited immune deficiency disorders characterised by inability to destroy phagocyted catalase positive bacterias due to lack of NADPH oxidase which results in formation of granulomas in different tissues.
Chronic hip subluxation most common occurs in paediatric patients with neuromuscular disorders (e.g. cerebral palsy). It is considered a form of developmental hip dysplasia.
Chronic hip subluxation occurs in ~45% of cerebral palsy patients who are not walking by 5 years of age 3....
Chronic recurrent multifocal osteomyelitis (CRMO) is an idiopathic inflammatory bone disorder seen primarily in children and adolescents. It is often a diagnosis of exclusion once underlying infection and neoplasia has been ruled out. However, there are some cases in which lesion location and mo...
The circumflex fibular artery is a minor artery of the leg.
Origin and course
Most often arises from the posterior tibial artery, passes laterally round the neck of the fibula through the soleus to anastomose with the lateral inferior genicular, medial genicular and anterior tib...
Clasp-knife deformity is relatively common congenital anomaly found at the lumbosacral junction.
Clasp-knife syndrome, is one of many causes of low back pain. It occurs when a clasp-knife deformity is accompanied by pain on extension secondary to protrusion of the enlar...
This classification of gamekeeper's thumb (also known as skier's thumb) was proposed by Hintermann et al 1 in 1993 and is based on whether a fracture is present and whether the injury is stable:
fracture present, which is non-displaced and stable in flexion
typically treated with a spl...
Classification of proximal femoral deficiency (PFFD) can be complicated and numerous such classifications have been proposed. For a discussion of the condition refer to the article proximal focal femoral deficiency.
One of the simplest and most widely used is that proposed by Aitken 1 which is ...
There are several classification systems for sacral fractures, but the most commonly employed are the Denis classification and subclassification systems, and the Isler classification system. These classification systems are important to understand as proper classification can impact management.
The clavicle (or informally collar bone) is the only bone connecting the pectoral girdle to the axial skeleton and is the only long bone that lies horizontally in human skeleton.
The clavicle is roughly "S-shaped" with a flattened, concave, lateral one-third and a thi...
The clavicle AP cephalic angulation view is a standard projection part of the clavicle series. Often used in conjunction with the AP clavicle, this projection straightens out the clavicle and projects it above overlaying anatomy.
patient is preferably erect
midcoronal plane o...
The clavicle AP view is a standard projection part of the clavicle series. The projection demonstrates the shoulder in its natural anatomical position allowing for adequate radiographic examination of the entire clavicle, as well as the acromioclavicular and sternoclavicular joints of the should...
Clavicle fracture usually occurs following trauma with a direct blow to the shoulder region, often following a fall.
This is a summary article. For more information, you can read a more in-depth reference article: clavicle fracture.
normal clavicle anatomy
The radiographic series of the clavicle is utilised in emergency departments to assess the clavicle, acromioclavicular and sternoclavicular joint.
Clavicle x-rays are indicated for a variety of settings including:
A clavicle series (or clavicle x-ray) is a set of two images taken of the clavicle to determine whether there is evidence of injury or bony abnormality.
This is a summary article. For more information, you can read a more in-depth reference article: clavicle series.
Clavicle tumours may be malignant or benign.
osteoma: uncommon, sclerotic, hamartomatous surface lesion
enchondroma: rare, geographic, intramed...
Clavicular fractures are common and account for 2.6-10% of all fractures 2-3. They usually require minimal treatment, which relies on analgesia and a collar-and-cuff. However, in some cases open reduction and internal fixation is required.
Fractures can occur at any part of the clavi...
The clavipectoral fascia is a sheet of loose connective tissue which is the deep layer of fascia in the pectoral region. It acts to suspend the floor of the axilla.
The clavipectoral fascia lies below the clavicular head of the pectoralis major. It fills in the space between the...
Clay-shoveler fractures are fractures of the spinous process of a lower cervical vertebra.
Often these injuries are unrecognised at the time and only found incidentally years later when the cervical spine is imaged for other reasons.
Acutely they tend to be associated wi...
Clear cell chondrosarcomas represent a chondrosarcoma subtype representing 1-2% of all chondrosarcomas. They are typically low-grade (see chondrosarcoma grading) and get their name from the presence of clear cell chondrocytes which have abundant vacuolated cytoplasm due to the presence of glycog...
Cleft epiphysis is a normal variant of an epiphysis. It can be either unilateral or bilateral. The most common site is the epiphysis of the first proximal phalanx of the foot.
Plain radiographs will demonstrate a lucent defect in the epiphysis. The borde...
Cleidocranial dysostosis (CCD), also known as cleidocranial dysplasia, is a rare skeletal dysplasia with predominantly membranous bone involvement, which carries an autosomal dominant inheritance 4.
large head, with large fontanelles with delayed closure
Clinodactyly is a descriptive term that refers to a radial angulation at an interphalangeal joint in the radio-ulnar or palmar planes. It typically affects the 5th finger.
The estimated incidence is highly variable dependent on sampling and has been reported to range between 1-18...
A cloaca (pl. cloacae/cloacas) can be found in chronic osteomyelitis.
The cloaca is an opening in an involucrum which allows drainage of purulent and necrotic material out of the dead bone. If the tract extends to the skin surface, the portion extending beyond the involucrum to the skin surface...
Closed reduction or manipulation is a common non-invasive method of treating mildly displaced fractures. Usually performed in an emergency department or orthopaedic clinic with light sedation and analgesia, the fracture is manipulated back into anatomic alignment and immobilised with a cast, bra...
Closed reduction-internal fixation, abbreviated to CRIF, refers to the orthopaedic operative management of a fracture (or fracture-dislocation complex) where closed reduction is performed (manipulation) and internal fixation is applied, usually in the form of K-wires to stabilise the fracture.
The Cobb angle is the most widely adopted technique to quantify the magnitude of spinal deformities, especially in the case of scoliosis, on plain radiographs. A scoliosis is defined as a lateral spinal curvature with a Cobb angle of 10° or more 4.
To measure the Cobb angle, one mu...
Cobb syndrome also called cutaneous vertebral medullary angiomatosis is a metameric vascular malformation that involves all three layers (ectoderm, mesoderm and neural tissue) of the same segmental dermatome.
The importance of this syndrome is the recognition that cutaneous vascular lesions may...
Coccidioidomycosis refers to an infection caused by the dimorphic fungus Coccidioides spp, usually localised to the lungs. This disease is not to be confused with the similarly named paracoccidioidomycosis.
The most common forms of Coccidioides spp are Coccidioides immitis and Coc...
Coccydynia refers to pain in and among the area of the coccyx. It is characterised by coccygeal pain which is typically provocated by pressure. It may remain unclear in origin owing to the unpredictability of the source of pain 1.
No accurate data about the frequency of coccydynia...
The coccygeus, also known as the ischiococcygeus, is a remnant muscle of the pelvic floor.
The coccygeus is a paired muscle which is triangular in shape and overlies the sacrospinous ligament. The coccygeus lies parallel to the inferior border of the piriformis, but is separated ...
The coccyx AP view is used to demonstrate the coccyx, in conjunction with the sacrum and coccyx (lateral view). Follow departmental protocol in relation to imaging this region.
the radiograph is performed with the patient in a supine position, with arms placed comfortably by ...
The cockade sign is a classic appearance of an intraosseous lipoma of the calcaneus which presents as a well-defined lytic lesion with a central calcification resembling a cockade.
It is named after a cockade, which is a badge, usually in the form of a rosette or knot, generally worn on the hat.
Codman triangle is a type of periosteal reaction seen with aggressive bone lesions. With aggressive lesions, the periosteum does not have time to ossify with shells of new bone (e.g. as seen in single layer and multilayered periosteal reaction), so only the edge of the raised periosteum will oss...
COL4A1-related disorders are a group of autosomal dominant disorders caused by a mutation in the COL4A1 gene.
The exact prevalence is unknown, but the group of disorders is considered to be under-recognised, especially asymptomatic variants 1.
The clinical ...
The collateral ligaments of the foot are attached to the dorsal tubercles on the metatarsal heads and the corresponding side of the phalangeal bases.
Colles fractures are very common extra-articular fractures of the distal radius that occur as the result of a fall onto an outstretched hand. They consist of a fracture of the distal radial metaphyseal region with dorsal angulation and impaction, but without the involvement of the articular surf...
Comminuted fractures are fractures where more than 2 bone components are created.
The problem with the term is that it includes a very heterogeneous group of fractures from a 3 part humeral head fracture to a multi-part fracture of the femur following a high-energy road traffic accident.
The common peroneal nerve, also known as common fibular nerve, forms the lateral part of the sciatic nerve and supplies the leg.
origin: one of two terminal branches of the sciatic nerve
course: diverges laterally to enter the lateral compartment of the leg
Companion shadows are smooth, homogeneous, radiopaque shadows running parallel along the bones. They appear secondary to soft tissues and intercostal muscles running along:
inferior border of lower ribs
upper borders of clavicles
Companion shadows need to be diff...
Complete fractures are fractures where the parts of the bone that have been fractured are completely separated from each other. There is complete separation of the cortex circumferentially.
Complete fractures can be classified as:
transverse: straight across the bone
oblique: oblique line acr...