SCLEROTIC BONE LESION
By Dr. KM LiauGenerally bone sclerosis signifies a slow-growing process. Bone reacts to disorder in two ways -- either by removing some of itself or by creating more of itself. If the disorder is rapidly progressive, there may only be time for retreat, hence bone resorption will occur giving rise to lytic lesion . If the process is slower growing, then the bone may have time to defend itself by forming a sclerotic border around the offender.
UNIVERSAL DIFFERENTIAL DIAGNOSIS
Mnemonic = VINDICATE
1. Vascular - hemangiomas, infarct(sickle cell).
2. Infection - Chronic osteomyelitis
3. Neoplasm
---A) Primary - Osteoma, Osteosarcoma
---B) Metastatic - Prostate, Breast
4. Drugs - Vitamin D, fluoride
5. Inflammatory/Idiopathic
6. Congenital - Osteopoikilosis, Osteopetrosis
7. Autoimmune
8. Trauma - Stress fracture
9. Endocrine/metabloic - Hyperparathyroidism, Paget's disease
1. Vascular - hemangiomas, infarct(sickle cell).
2. Infection - Chronic osteomyelitis
3. Neoplasm
---A) Primary - Osteoma, Osteosarcoma
---B) Metastatic - Prostate, Breast
4. Drugs - Vitamin D, fluoride
5. Inflammatory/Idiopathic
6. Congenital - Osteopoikilosis, Osteopetrosis
7. Autoimmune
8. Trauma - Stress fracture
9. Endocrine/metabloic - Hyperparathyroidism, Paget's disease
HEMANGIOMA
Hemangiomas are benign lesions characterized by vascular spaces lined with endothelial cells.
Approximately 50% of osseous hemangiomas are found in the vertebral bodies (thoracic especially) and 20% in the calvarium.
The remaining lesions are found in the tibia, femur and humerus.
Approximately 50% of osseous hemangiomas are found in the vertebral bodies (thoracic especially) and 20% in the calvarium.
The remaining lesions are found in the tibia, femur and humerus.
HEMANGIOMA ANGIOGRAM
Hemangioma Link List
- Hemangioma
- Learn more about hemangioma here.
- Hemangioma 2
- Learn more & more about hemangioma.
SICKLE CELL
Musculoskeletal Manifestations
* Infarction
* Marrow Hyperplasia
* Spontaneous Fracture
* Growth Disturbance
* Osteomyelitis
* Arthritis (septic-reactive)
* Dactylitis
X ray finding:
* Thinning of cortex
* Dense amorphous chalky zones ( Infarcts )
* Infarction
* Marrow Hyperplasia
* Spontaneous Fracture
* Growth Disturbance
* Osteomyelitis
* Arthritis (septic-reactive)
* Dactylitis
X ray finding:
* Thinning of cortex
* Dense amorphous chalky zones ( Infarcts )
SICKLE ANAEMIA WITH AVN OF HEAD OF FEMUR
40 year old lady with left hip pain - Mechanical pain.
Patchy sclerosis is particularly marked over the proximal femoral metaphyses and diaphyses.
There is a bone-within a bone appearance, particularly in the diaphysis of the left femur that implies an intermittent process.
The head of the left femur is flattened and broadened.
The curvatures of both surfaces of the left hip no longer correspond as the centre of the neck of left femur has migrated upwards and outwards.
The right hip joint surfaces are congruent, despite the sclerosis of that femoral head.
There is osteophytic lipping at the margins of the acetabulum on both sides.
Diagnosis: AVN of Left Head of Femur Ficat Stage 4
Patchy sclerosis is particularly marked over the proximal femoral metaphyses and diaphyses.
There is a bone-within a bone appearance, particularly in the diaphysis of the left femur that implies an intermittent process.
The head of the left femur is flattened and broadened.
The curvatures of both surfaces of the left hip no longer correspond as the centre of the neck of left femur has migrated upwards and outwards.
The right hip joint surfaces are congruent, despite the sclerosis of that femoral head.
There is osteophytic lipping at the margins of the acetabulum on both sides.
Diagnosis: AVN of Left Head of Femur Ficat Stage 4
Sickle Cell Link List
- AVN Hip
- Click here for large picture of Hip AVN
- AVN in sickle cell disease
- AVASCULAR NECROSIS OF THE HIP IN SICKLE CELL DISEASE
CHRONIC OSTEOMYELITIS
Skeletal manifestations include unifocal or multifocal bone lesions, which are lytic and destructive in the early phase, and sclerotic and reactive in the late phase, occurring in any bone.
The metaphyseal area of long bones, the clavicle, and the shoulder girdle are common locations.
The metaphyseal area of long bones, the clavicle, and the shoulder girdle are common locations.
Chronic Osteomyelitis Link List
- Chronic Recurrent Multifocal Osteomyelitis
- Chronic Recurrent Multifocal Osteomyelitis
- Hyperbaric Oxygen Therapy
- Hyperbaric Oxygen Therapy and Chronic Osteomyelitis
OSTEOID OSTEOMA
Osteoid Osteoma is a benign bone lesion with a nidus of less than 2 cm surrounded by a zone of reactive bone.
Osteoid osteoma has a distinct clinical picture of dull pain that is worse at night and disappears within 20 to 30 minutes of treatment with non-steroidal anti-inflammatory medication.
4 diagnostic features include
(1) a sharp round or oval lesion
(2) less than 2 cm in diameter,
(3) has a homogeneous dense center
(4) a 1-2 mm peripheral radiolucent zone.
Osteoid osteoma has a distinct clinical picture of dull pain that is worse at night and disappears within 20 to 30 minutes of treatment with non-steroidal anti-inflammatory medication.
4 diagnostic features include
(1) a sharp round or oval lesion
(2) less than 2 cm in diameter,
(3) has a homogeneous dense center
(4) a 1-2 mm peripheral radiolucent zone.
Osteoid Osteoma Link List
- Osteoid osteoma
- Learn more about osteoid osteoma
OSTEOSARCOMA
Features of osteosarcoma:
1. Osteoblastic (bone forming)
(note a rare variant which is osteolytic and
resemble aneurysmal bone cyst - telangiectatic
osteosarcoma)
2. Sun ray spicules (Radial ossification) and Codmans triangle (lifting of periosteum)
3. Wide zone of transition.
4. Cortical breach common
5. Adjacent soft tissue mass
6. Joint space rarely involved
1. Osteoblastic (bone forming)
(note a rare variant which is osteolytic and
resemble aneurysmal bone cyst - telangiectatic
osteosarcoma)
2. Sun ray spicules (Radial ossification) and Codmans triangle (lifting of periosteum)
3. Wide zone of transition.
4. Cortical breach common
5. Adjacent soft tissue mass
6. Joint space rarely involved
New Link List
- Osteosarcoma
- Learn more about osteosarcoma
PROSTATE METASTASIS
In male patient always think of prostate metastasis whenever you see blastic lesion in the vertebra.
Always do a per rectal examination (or be prepared to get screwed!!!)
Always do a per rectal examination (or be prepared to get screwed!!!)
BREAST METASTASIS
In female patients, always think of breast cancer.
They can present either as lytic or blastic lesion.
The picture shows blastic lesion over L1, L2, L3 vertebrae.
They can present either as lytic or blastic lesion.
The picture shows blastic lesion over L1, L2, L3 vertebrae.
New Link List
- Breast canser metastasis
- Case study on breast cancer metastasis
FLUOROSIS
Recent immigrant from India with a stiff back and bad teeth.
There is a widespread patchy increase in bone density with ossification of capular ligament insertions of hip and intervertebral joints and particularly of the sacro-iliac joints.
There is a widespread patchy increase in bone density with ossification of capular ligament insertions of hip and intervertebral joints and particularly of the sacro-iliac joints.
New Link List
- Fluorosis large picture
- Click here to see large picture
OSTEOPETROSIS
Rare hereditary disorder
Defective osteoclast function with failure of proper reabsorption produces sclerotic bone
Structurally weak bone.
X-ray findings:
Diffuse osteosclerosis
Cortical thickening with medullary encroachment
Erlenmeyer flask deformity = clublike long bones due to lack of tubulization + flaring of ends
Bone-within-bone appearance
"Sandwich" vertebrae=alternating sclerotic + radiolucent transverse metaphyseal lines (phalanges, iliac bones) indicate fluctuating course of disease
Longitudinal metaphyseal striations
Defective osteoclast function with failure of proper reabsorption produces sclerotic bone
Structurally weak bone.
X-ray findings:
Diffuse osteosclerosis
Cortical thickening with medullary encroachment
Erlenmeyer flask deformity = clublike long bones due to lack of tubulization + flaring of ends
Bone-within-bone appearance
"Sandwich" vertebrae=alternating sclerotic + radiolucent transverse metaphyseal lines (phalanges, iliac bones) indicate fluctuating course of disease
Longitudinal metaphyseal striations
Osteopetrosis - Spine
- Osteopetrosis Spine
- Click here for large photo.
STRESS FRACTURE
Commonly occur among athletes who has undergone continuous vigorous training.
Note the fine lucent line involving 1 cortex only and mild periosteal reaction.
Abscence of lytic or blastic lesion and normal medullary canal rules out other pathologies.
Note the fine lucent line involving 1 cortex only and mild periosteal reaction.
Abscence of lytic or blastic lesion and normal medullary canal rules out other pathologies.
Stress Fracture Link List
- Stress fracture
- Learn more about stress fracture at wikepidia.
- Common Stress Fracture
- Learn more about common stress farcture at Journal of American Academy of Family Physician.
SECONDARY HYPERPARATHYROIDISM
Soft tissue calcification are common
Calcified deposits around joints may mimic tumoral calcinosis (Picture)
NOTe: Brown tumors due to primary hyperparathyroidism are LYTIC and they are less common.
Calcified deposits around joints may mimic tumoral calcinosis (Picture)
NOTe: Brown tumors due to primary hyperparathyroidism are LYTIC and they are less common.
Hyperparathyroidism Link List
- Wikipedia
- Learn more about secondary hyperparathyroidism at Wikipedia.
PAGET'S DISEASE
This is a disease more common in the Western countries.
Very rare in Malaysia.
Imaging Findings:
* Classical triad of:
o Thickening of the cortex
o Accentuation of the trabecular pattern
o Increased size of bone
Associated neoplasia (0.7-20%)
* Sarcomatous transformation into osteosarcoma (22-90%)
* Fibrosarcoma /malignant fibrous histiocytoma (29-51%)
* Chondrosarcoma (1-15%)
Very rare in Malaysia.
Imaging Findings:
* Classical triad of:
o Thickening of the cortex
o Accentuation of the trabecular pattern
o Increased size of bone
Associated neoplasia (0.7-20%)
* Sarcomatous transformation into osteosarcoma (22-90%)
* Fibrosarcoma /malignant fibrous histiocytoma (29-51%)
* Chondrosarcoma (1-15%)
Paget Link List
- Paget Disease
- Learn more about Paget Disease here.
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