Radiological Mimickers of Physical Child Abuse
B. G. Brogdon, Tor Shwayder, Jamie Elifritz in Child Abuse and Its Mimics in Skin and Bone, 2012
Periosteal reaction to a number of stimuli results in the production of osteoblastic activity and subsequently, new bone formation. The latter is required before the periosteal reaction can be appreciated radiographically. Traumatic stresses on the dynamically active periosteum of infants and children are discussed and illustrated in Chapter 2. Here we focus on nontraditional etiologies of periosteal reaction. The distinction between traumatic and nontraumatic causes may be challenging because in either case there often are associated metaphyseal abnormalities, discussed earlier in this chapter. Careful scrutiny of the entire bone in conjunction with careful consideration of clinical history or other context is essential.
Extended matching item (EMI)
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon in Radiology for Undergraduate Finals and Foundation Years, 2018
Match the clinical questions below to the above list options. What is the most likely diagnosis given the imaging findings and the patient’s age?What is the type of periosteal reaction described?What is the best initial investigation for assessment of the lesion?List two most appropriate imaging examinations for staging.
Primary bone tumours
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
Radiographs demonstrate an aggressive destructive lesion with a wide zone of transition and ill-defined margins. There may be expansion of the involved bone, and pathological fractures are relatively frequent (52). Periosteal reaction including the presence of a Codman angle is often seen, as is the presence of a soft tissue mass (51). MRI may demonstrate areas of low signal intensity on both T1W and T2W sequences, though, frequently, the MRI appearances are non-specific and indistinguishable on imaging from undifferentiated high-grade pleomorphic sarcoma.
Intra-osseous tophaceous gout of a bipartite patella mimicking aggressive bone tumour
Published in Modern Rheumatology Case Reports, 2021
Fidelis Marie Corpus-Zuñiga, Keiichi Muramatsu, Ma. Felma Rayel, Yasuhiro Tani, Tetsuya Seto
A 31 year-old male nurse came to the orthopaedic clinic, initially because of a direct fall on his left knee. Past medical history showed that he already had an injury on his left knee 10 years prior and was diagnosed with a bipartite patella classified as Saupe type III. His initial radiographs revealed cystic lesion connected to the separation site of the patella (Figure 1). Gradual resolution of pain was noted, however, after a month the pain recurred and he came back to the clinic. His primary physician then requested for a computed tomography (CT) scan which showed intraosseous lesion of the patella and the osteosclerotic changes surrounding the intrapatellar lesion. Periosteal reaction, suggesting malignant bone tumour was not observed (Figure 2). Although his pain improved again after a month, there was recurrence of the anterior knee pain. A repeat CT scan revealed enlargement of the bone lesion, suspected aggressive bone tumour. Magnetic resonance imaging (MRI) showed heterogeneous low and high signal intensity masses on T1- and T2-weighted images and enhancement of the lesion by gadolinium contrast (Figures 3, 4). The border between the patella and intrapatellar lesion was clear. He was referred to Nagato general hospital for surgical management.
Can MRI differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma? A systematic review
Published in Acta Orthopaedica, 2020
Claudia Deckers, Maarten J Steyvers, Gerjon Hannink, H W Bart Schreuder, Jacky W J de Rooy, Ingrid C M Van Der Geest
In cartilaginous tumors production of chondroid matrix results in the typical lobulated growth pattern and the so-called ring and arc appearance (Logie et al. 2013). In HGCS these typical chondroid features become lost due to poor differentiation of cells. Chondrosarcoma cells actively infiltrate between individual fat cells, compressing and eventually replacing them (Brien et al. 1997). Absence of areas of entrapped fat is therefore highly indicative of HGCS. In addition, invasion of Haversian systems leads to periosteal reaction. Eventually there is destruction of the cortex and invasion of soft tissue (Brien et al. 1997). Yoo et al. (2009) found that on gross pathological evaluation, a central non-enhancing region corresponded to an area of hemorrhagic cyst, necrosis, and/or yellow-brown soft tissue mass reflecting a myxoid change, all characteristics of malignant tumors.
Touraine–Solente–Gole syndrome
Published in Orbit, 2018
Blood investigations including complete blood count with peripheral smear examination, renal function test, liver function test, thyroid function test, serum calcium, phosphate, serum alkaline phosphatase, growth hormone and parathyroid hormone assay were normal. Rheumatoid factor, C reactive protein, anti-citrullinated peptide antibody, VDRL and ANA profile including C-ANCA, P-ANCA and Anti Ds DNA antibody were negative. There was no albuminuria. Ultrasonography of abdomen and electrocardiogram (ECG) were normal. CT scan of abdomen and chest was done to rule out causes of secondary PDP. X-ray radiography and radiological consultation were done. X-rays of skull and chest were unremarkable. X-rays of hands and knees showed a periosteal reaction, subperiosteal new bone formation and cortical thickening without narrowing of the medullary cavity (Figure 6). After summing up the clinical examination, radiological evaluation and ruling out other secondary causes, a diagnosis of Touraine–Solente–Gole syndrome was made. Genetic testing was advised but denied by the patient. For initial management, we referred the patient for rheumatologic opinion and treatment started with nonsteroidal anti-inflammatory drugs (NSAIDs), short course of steroids and intravenous pamidronate. For blepharoptosis, bilateral blepharoplasty with horizontal tarsal wedge resection was advised.
Related Knowledge Centers
- Bone
- Bone Healing
- Hematoma
- Stress Fracture
- Bone Fracture
- Osteomyelitis
- Periosteum
- Injury
- X-Ray
- Chronic Condition