Top 3 Differentials in Musculoskeletal Imaging. A Case Review

I Trauma
1 Shoulder dislocation
2 Distal clavicular erosion
3 Widening of AC joint
4 Fracture dislocation of forearm
5 Carpal dislocation
6 Avulsion fracture of finger
7 Avulsion fracture of the pelvis
8 Widened pubic symphysis
9 Pelvic ring disruption
10 Avulsion fracture at the knee
11 Distal fibular fracture
12 Calcaneal avulsion fracture
13 Fracture at the base of the fifth metatarsal
II Bone Tumors
14 Aggressive periosteal reaction
15 Focal cortical thickening
16 Epiphyseal equivalent lucent lesion
17 Solitary focal sclerotic lesion
18 Lesion with permeative or moth-eaten pattern
19 Osseous lesion with fluid–fluid levels
20 Osseous lesion with chondroid matrix
21 Osseous lesion with osteoid matrix
22 Polyostotic lesions- looks like a syndrome
23 Surface lesion of bone
24 Multiple lytic lesions
25 Multiple sclerotic lesions
26 Expansile lytic lesion of rib
27 Ivory vertebral body
28 Lytic lesion of distal phalanx
29 Anterior tibial cystic appearing lesion
30 Lucent lesion in calcaneus
31 Diffusely increased bone density
32 Well-marginated ossific mass projecting off the surface of the bone (without full-thickness cortical disruption or overlying soft-tissue mass)
33 Long lesion in a long bone with ground glass matrix
34 Bony projection with continuation of cortex and medullary cavity of host bone
35 Fractured lytic lesion with a fallen fragment
III Upper Extremity
36 Abnormal/variant appearance of anterosuperior labrum
37 Abnormality of inferior glenohumeral ligament.
38 Abnormality of proximal long head of biceps tendon
39 Tear of the anteroinferior labrum
40 Bursa or cyst around shoulder
41 Rotator cuff abnormality
42 Rotator interval abnormality
43 Posterior glenoid labral tear
44 Nerve entrapment at shoulder
45 Nerve entrapment at elbow
46 Distal biceps tendon abnormality
47 Radial sided soft tissue injury at elbow on MRI
48 Osteochondral lesion of elbow
49 Ulnar sided stabilizer injury at elbow on MRI
50 Numerous tiny T2 hyperintense subcutaneous nodules in hand
IV Lower Extremity
51 Variant sciatic nerve anatomy
52 Ischiofemoral space narrowing and quadratus femoris muscle edema in a patient with chronic ischial tuberosity avulsion (nonunion)
53 Small smoothly marginated depression ("fossa") at the mid acetabular roof
54 Focal subchondral bone edema in the femoral head
55 Low grade tearing of the ITB with soft tissue edema along the fascia
56 Focal periphyseal edema
57 Curvilinear signal separating the patella into two fragments
58 Frond-like lobules of fatty tissue in the suprapatellar recess, with effusion (lipoma arborescens
59 Cystic-appearing lesion centered inferior to the medial joint line of the knee
60 Accessory muscle around ankle
61 Accessory ossicle around ankle
62 Achilles tendon abnormality
63 Impingement syndrome at ankle
64 Ankle sprain
65 Medial tendon abnormality at ankle
66 Nerve entrapment around ankle and foot
67 Plantar fascial abnormality
68 Peroneal tendon disease at the ankle
69 Midfoot ligamentous or osseous injury
70 Hallux sesamoid abnormality
71 Subchondral crescent sign
72 Fluid collection at the inferomedial aspect of hip-Roentgen classic
73 Cleft of T2 hyperintense signal at the attachment of rectus abdominis-adductor aponeurosis
74 Hamstring tendon discontinuity with subacute hematoma
V Arthropathy
75 Intense, diffuse, nontraumatic bone and soft tissue edema centered at the midfoot
76 Polyarticular arthritis in an adolescent, with blooming intraarticular hemosiderin
77 Bilateral sacroiliitis
78 Contour defect at the posterolateral humeral head
79 Proximal arthropathy affecting primarily the metacarpophalangeal joints.
80 Distal arthropathy affecting primarily the interphalangeal joints
81 Erosive arthropathy involving the foot
82 Acro-osteolysis
83 Loose bodies
84 Articular cartilage thinning, subchondral cyst formation and dorsal subluxation of the metacarpal base
VI Infection
85 Penumbra sign
86 Sequestrum
87 Abscesses in bone and adjacent to bone, with thin perforations in cortex
88 Space occupying lesion posterior to olecranon
89 Unilateral sacroiliitis
90 Epitrochlear lymphadenopathy
91 Aggressive, cortically based osteolysis and periosteal reaction at the diaphysis of an adult long bone
92 Fluid collection with edema at metaphyseal equivalent location
VII Soft Tissue Tumors
93 Fusiform mass, with longitudinal "tail" entering and exiting eccentrically
94 Complex fluid collection in the bicipitoradial bursa
95 Infrascapular soft-tissue mass containing diffuse streaks of fatty tissue
96 Non-mineralized soft-tissue mass with an infilt

LOOK INSIDE

The highest-yield musculoskeletal radiology exam prep and learning tool available today!

Top 3 Differentials in Musculoskeletal Imaging: A Case Review by Jasjeet Bindra, Robert D. Boutin, and expert contributors is one in a series of radiology case books mirroring the format of the highly acclaimed O'Brien classic, Top 3 Differentials in Radiology: A Case Review. The book is organized in 10 parts: trauma, bone tumors, upper extremity, lower extremity, arthropathies, infection, soft tissue tumors, metabolic musculoskeletal conditions, spine, and pediatric/developmental musculoskeletal conditions.

Each case is formatted as a two-page unit. The left page features clinical images, succinctly captioned findings, and pertinent clinical history. The right page includes the key imaging gamut, differential diagnoses, additional diagnostic considerations, the diagnosis, clinical pearls, and suggested readings.

• A total of 146 cases, each focused on a specific imaging finding, including aggressive periosteal reaction, focal cortical thickening, diffusely increased bone density, focal periphyseal edema, acro-osteolysis, and more
• A wealth of meticulously selected, high-quality radiographs, CTs, and MRIs enhance diagnostic skills
• A list of differential diagnoses provides an ideal curriculum guide for trainees and educators alike

Radiology residents, fellows, and staff radiologists preparing for certification will greatly benefit from reading this text to prep for the radiology core and certifying exams. This is also an outstanding, day-to-day practice resource for practicing radiologists, clinicians, and orthopaedic surgeons involved in reviewing and interpreting musculoskeletal radiology studies.