LOWER LIMB PATHOLOGY
CONDITION OR
DISEASE
Bone cyst
Chondromalacia patellae
MOST COMMON
RADIOGRAPHIC
EXAMINATION
AP and lateral of affected
limb
AP and lateral knee,
tangential (axial) of
patellofemoral joint
Chondrosarcoma
AP and lateral of affected
limb, CT, MRI
Enchondroma (benign
cartilaginous tumor)
AP and lateral of affected
limb
Ewing sarcoma (malignant
bone tumor)
AP and lateral of affected
limb, CT, MRI
Exostosis
(osteochondroma)
AP and lateral of affected
limb
Gout (a form of arthritis)
AP (oblique) and lateral of
affected part (most
common initially in MTP
joint of foot)
Weight-bearing AP and
lateral and 30-degree
medial oblique
projections, CT, MRI
Lisfranc joint injury
Multiple myeloma (most
common primary
cancerous bone tumor)
Osgood-Schlatter disease
AP and lateral of affected
part
Osteoarthritis
(degenerative joint disease)
AP, oblique, and lateral of
affected part
Osteoclastoma (giant cell
tumor)
AP and lateral of affected
part
Osteogenic sarcoma
(primary bone tumor)
AP and lateral of affected
part, CT, MRI
AP and lateral of knee
POSSIBLE
RADIOGRAPHIC
APPEARANCE
Well-circumscribed
lucency
Pathology of
patellofemoral joint space,
possible misalignment of
patella
Bone destruction with
calcifications in
cartilaginous tumor
Well-defined radiolucent
tumor with thin cortex
(often results in pathologic
fracture with minimal
trauma)
Ill-defined area of bone
destruction with
surrounding “onion peel”
(layers of periosteal
reaction
Projection of bone with
cartilaginous cap; grows
parallel to shaft and away
from nearest joint
Uric acid deposits in joint
space; destruction of joint
space
EXPOSURE FACTOR
ADJUSTMENT
Abnormal separation or
avulsion fracture between
base of first and second
metatarsals and
cuneiforms
Multiple “punched-out”
osteolytic lesions
throughout affected bone
Fragmentation or
detachment of tibial
tuberosity by patellar
tendon
Narrowed, irregular joint
spaces with sclerotic
articular surfaces and
spurs
Large radiolucent lesions
with thin strips of bone
between
Extensively destructive
lesion with irregular
periosteal reaction; classic
appearance is sunburst
pattern that is diffuse
periosteal reaction
Slight increase in exposure
factors to penetrate tarsal
region of foot
Advanced stage may
require slight decrease ( - )
LOWER LIMB PATHOLOGY
Osteoid osteoma (benign
bone lesions)
Osteomalacia (rickets)
AP and lateral of affected
part
AP and lateral of affected
limb
Paget disease (osteitis
deformans)
AP and lateral of affected
parts
Reiter syndrome
AP and lateral of affected
part
Small, round-to-oval
density with lucent center
Decreased bone density,
bowing deformity in
weight-bearing limbs
Mixed areas of sclerotic
and cortical thickening
and lytic or radiolucent
lesions; cotton wool
appearance
Asymmetric erosion of
joint spaces; calcaneus
erosion, usually bilateral
Loss of bone matrix
requires decrease ( - )
Extensive sclerotic areas
may require increase ( + )