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CC My 2017 Bone cysts

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echoecho's version from 2017-05-15 17:06

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Question Answer
What are the most common forms of benign bone lesions?Unicameral or simple bone cysts
How are bone cysts found?incidentally on x-ray
Are bone cysts frequently asymptomatic?yes
Most are identified as benign lesions on what film and recognizing what may prevent unnecessary imaging or medical intervention?1) plain 2) classic presentation
Describe what simple bone cysts appear on x-ray?1) as well-defined lesions with smooth borders and no relative sclerosis of the surrounding bone tissue 2) lesion typically expands the full diameter of the affected bone and can expand into the cortex
What sign often appears in the unicameral cysts that present with pathological fracture?"fallen leaf" sign with the splintered bone (the "leaf') present in the bottom of the cyst
What other imaging is needed to confirm the diagnosis if plain x-ray is equivocal?CT or MRI
Regarding unicameral cysts, these are common seen in what group?children
What is the ratio of male to female of unicameral cysts?2-3:1
85% of of unicameral cysts are found in the first ___ decades of life with the majority discovered in children ___ to ___ years of age?two; 11;18
Unicameral cysts often affect which bone but can vary in size and location?proximal femur or humerus
What is unicameral bone cysts thought to be caused by?abnormal bone development or a reactive process RATHER than neoplastic activity
Unicameral cysts located close tot he growth plate are considered _____ cysts and those that are located away from the growth plate are considered ___ cysts?active; latent
What can active unicameral cysts do?they can invade the growth plate and affect future bone maturation and development and occasionally need more aggressive management
Larger unicameral cysts near the joint may cause what?pain, local swelling or joint stiffness
*** Can the natural course of a unicameral cyst vary and is it easy to predict?yes; no
*** Larger cysts and those involving the growth plate increase the risk of what (the most common complication associated with unicameral cysts)?pathological fracture
*** Occasionally, a pathological fracture is the presenting feature of a unicameral cyst, true or false?true
Are unicameral cysts benign?yes
Do unicameral cysts become malignant?no
Do unicameral cysts lead to anemia or hypercalcemia?no, no
What is the management of a unicameral bone cyst?1) depends on size and location of cyst and potential risk of fracture 2) small cysts are watched with serial plain films every 4-6 months 3) as the child grow, the cyst will remodel and eventually fill with normal bone 4) if the lesion is large and fracture risk is high, appropriate limitations of activity should be recommended and surgery considered
What is the active management of large or active cysts?1) current age and bone grafting 2) intramedullary nailing 3) diaphysectomy with bone graft or injection with glucocorticoids or autogenous bone marrow (ABMI)
What is the most aggressive treatment approach and what are the complications?1) diaphysectomy 2) usually successful but with significant associated morbidity
Recurrence rates for all interventions are _________ to ___ % and are especially high when what is employed?1) 25-50% 2) curettage and bone grafting
In some studies, ABMI (autogenous bone marrow) has been found to be more effective than ____ injections? Comment on the recurrence rate and morbidity?1) steroid 2) lower recurrence rates and much lower morbidity
Is the cyst index used in the past indicated?no as it may be less accurate than once thought
What maybe required in the presence of a pathological fracture?surgical stabilization
What is the diff diagnosis for unicameral bone? Explain?1) aneurysmal bone cyst 2) less common but may expand rapidly 3) more likely to lead to a pathological fracture 4) highly vascular 5) require MRI to confirm do
Because aneurysmal bone cysts often present with pain or with a pathological fracture, and because they are more apt to lead to a fracature, what injection is used?an injection with a fibrosing agent, embolization, or surgical intervention
*** SUMMARY = Simple bone cysts are usually located in what two bones? Are they symptomatic?1) femur or humerus 2) rarely
*** SUMMARY = Small lesions can be observed with ____ x-rays. Small lesions often do what?1) serial 2) remodel and spontaneously resolve
*** SUMMARY = Larger lesions or those near a joint space may require what?intervention, but reoccurrence is common
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