X-ray Findings Tutorial

Acute and Degenerative Bone & Joint Pathologies and Features on X-ray

Apart from basic bone fractures and joint dislocations, there are several other specific features and pathologies that can be identified in X-ray images. These often result from progressive, degenerative, or healing changes in bone or cartilaginous tissues. Below, we explain the most commonly used terms to describe these findings. For a more in-depth understanding and explanation of the pathologies, their causes, and relationships, please scroll down for a basic explanatory tutorial.

TermX-ray Appearance & Context
Osteoarthritis: Degenerative joint condition marked by cartilage breakdown.Joint space narrowing, subchondral sclerosis, and osteophyte formation. Common in elderly patients or after chronic overuse.
Osteophytes: Bony projections that develop along the edges of bones.Bony spurs seen at joint margins. Commonly associated with osteoarthritis and joint degeneration.
Rheumatoid Arthritis: Chronic inflammatory disorder affecting joints.Soft tissue swelling, joint space narrowing, and marginal erosions. More symmetrical than osteoarthritis and involves smaller joints like fingers.
Periosteal Reaction: Response of the periosteum to injury or irritation.New bone growth parallel to the bone shaft, can be solid, laminated, or spiculated. Seen in trauma, infections, tumours, and stress fractures.
Callus Formation: Natural bone healing response after a fracture.Bulbous, cloud-like bone formation around the fracture site. Appears weeks after fracture during the healing phase.
Osteomyelitis: Infection in bone, typically bacterial.Bone destruction, periosteal reaction, and potential abscess formation. Following trauma, surgery, or a blood-borne infection.
Sclerosis: Hardening or thickening of tissue.Increased bone density or whiteness. Seen in areas of stress or as part of pathological changes.
Sesamoid Bone: Small, round bones embedded in tendons.Small, round, dense bones near joints, e.g., thumb and big toe.
OS Peroneum: A sesamoid bone in the peroneus longus tendon.Small, round bone near the cuboid bone in the foot. Can be injured in foot trauma.
Old Non-united Fracture – A fracture that hasn’t healed properly.Visible fracture line without bridging bone, with sclerosis at fracture ends. Sometimes round bone formations can also be present, especially in areas like the ulna.
Ossification: Bone formation process.New bone formation. Part of normal growth or in response to stimuli.
Calcification: Deposition of calcium salts in tissues.Dense, whitish areas in soft tissues or blood vessels. Found in ageing vessels, tumours, or tissue injury.
Effusion: Accumulation of fluid within a joint space (ie. blood, fat, synovial fluid).Swallen, often radiolucent area indicating fluid collection. Due to trauma, inflammation, infection, or other joint pathology.
Hemarthrosis: Accumulation of blood within a joint.Often causes raised fat pads in areas like the elbow. Common after fractures that communicate with joints.
Lipohemarthrosis: Mixture of fat and blood within a joint.On X-rays, fat layers above the blood due to lower density. Indicative of intra-articular fractures like tibial plateau fractures in the knee.

TermX-ray Appearance & Context
Osteoarthritis
(Joint wear)
Age-related or overuse joint wear reducing cartilage. On X-ray: Shows joint space narrowing, bone density increase (sclerosis), and osteophytes (spurs).
Rheumatoid Arthritis
(Inflammatory disease)
Autoimmune joint inflammation, symmetrical across the body, affecting smaller joints. On X-ray: Presents with soft tissue swelling, joint space narrowing, and erosions.
Periosteal Reaction
(Bone response)
The periosteum’s reaction to injury or irritation by creating new bone. On X-ray: Visible as new bone growth parallel to the bone shaft.
Callus Formation
(Fracture healing)
Bone’s natural healing response after a fracture. On X-ray: Appears as a bulbous, cloud-like formation around the fracture site.
Osteophytes
(Bone spurs)
Bony projections at joint margins due to stress or degeneration. On X-ray: Seen as spurs at joint edges, often related to osteoarthritis.
Osteomyelitis
(Bone infection)
Infection leading to bone damage. On X-ray: Evident through bone destruction, periosteal reaction, and potential abscess formation.
Sclerosis
(Bone hardening)
Hardening or thickening of bone tissue. On X-ray: Manifests as increased bone density or whiteness.
Sesamoid Bone
(Tendon bone)
Small, round bones within tendons. On X-ray: Appear as small, round, dense bones near joints.
OS Peroneum
(Foot sesamoid)
A specific sesamoid bone in the foot. On X-ray: Shows as a small, round bone near the cuboid.
Old Non-united Fracture
(Unhealed fracture)
A fracture that hasn’t healed properly. On X-ray: Visible fracture line without a bridging callus.
Ossification
(Bone formation)
The process of new bone tissue formation. On X-ray: New bone formation is evident.
Calcification
(Calcium deposits)
Deposition of calcium salts in tissues. On X-ray: Dense, whitish areas in soft tissues or in blood vessels.
Effusion
(Fluid accumulation)
Accumulation of fluid within a joint space. On X-ray: Radiolucent area indicating fluid collection.
Hemarthrosis
(Blood in joint)
Accumulation of blood within a joint space. On X-ray: Often causes raised fat pads in areas like the elbow.
Lipohemarthrosis
(Fat-blood mix)
Mixture of fat and blood within a joint. On X-ray: Fat layers above blood due to lower density.