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Additional resources for Bone and joint disorders: differential diagnosis in conventional radiology

Sample text

Fibrous dysplasia (polyostotic form) (Fig. 48) Similar to Paget’s disease. Can present as diffuse sclerosis of the involved bone associated with widening and cortical thickening. The manifestations are predominantly unilateral, and bone deformities are common. Clinically, “cafe-au-lait” pigmentations with irregular outline (“coast of Maine” appearance) are found in approximately one third of patients with the polyostotic form. Alkaline phosphatase is normal or only mildly elevated. Mastocytosis Can present throughout the skeleton as diffuse sclerosis that is not sharply demarcated from normal bone and often intermingled with osteolytic areas.

A chip fracture has the same radiographic appearance, but is caused by direct impact. b Transverse fracture (secondary to shearing force to opposite sides of a bone or to impact force along transverse axis). An oblique fracture (not shown) occurs secondary to impact along an oblique axis. c Spiral fracture (secondary to rotary-type injury). resorption along the fracture margins becomes evident and in undisplaced fractures may allow at this stage (several days after the injury incidence) an unequivocal radiographic diagnosis.

Hyperphosphatemia may also be present. Pachydermoperiostosis (primary hypertrophic osteoarthropathy) (Fig. 12) Long tubular bones, especially radius, ulna, tibia and fibula. Less common in metacarpals, metatarsals, and phalanges, pelvis, ribs and clavicles. Generalized and symmetrical. May extend from the diaphyses into the metaphyses and epiphyses (DD: Secondary hypertrophic osteoarthropathy, where it does not extend into the epiphyses). Solid thick, often with shaggy, irregular excrescences Familial condition with skin thickening and cortical thickening.

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