Musculoskeletal radiology findings in skeletal dysplasias and metabolic bone diseases

Musculoskeletal radiology
TONY SCARIA 2010 KMC

Short stature
• Height < 3rd centile for chronological age of patient
Proportionate
Disproportionate Short trunk
Short limbed Rhizomelic (proxima)
Mesomelic (middle)
Acromelic (distal)

Rhizomelic dysplasia Mesomelic dysplasia Acromelic dysplasia
• Achondroplasia
• Thanatophoric dysplasia
• Achondrogenesis
• Metatrophic
• Hypochondroplasia
• Chondroectodermal dyspasia
• Madelung deformity
• Asphyxiating thoracic dysplasia
/jeunes syndrome

• Clover leaf skull
• Telephone handle long
bones

Clover leaf skull
• Thanatophoric dysplasia

Asphyxiating thoracic dysplasia

Achondroplasia

Intrinsic disturbance of
formation growth
remodelling of bone &
cartilage d/t genetic &
inborn biochemical
errors
Achondroplasia
Hypochondroplasia

Achondroplasia
• MC of Rhizomelic dwarfism
• MC form of skeletal dysplasia
• Risk increases with increasing paternal age
• AD
• Spontaneous mutation in 80 %

Achondroplasia
• Defect in endochondral ossification of bones
• Membranous & periosteal ossification are undisturbed

AD condition with FGFR3 affection in
achondroplasia

CF of achondroplasia
• Disproportionate dwarfism
• Short limb out of proportion to trunk
• Trident hand
• Flexion contracture elbow
• Radial head subluxation
• Skull is large with bulging vault & forehead
• Intelligence & sexual development is normal
• Joints & cartilage are normal
• Dorsolumbar kyphosis increased lumbar lordosis
• Lumbar stenosis

Trident hand / star fish hand

Frontal bossing
Fingers reach upto grat
Trident hand

Trident hand sign in achondroplasia
A trident hand is a description where the hands are short with
stubby fingers, with a separation between the middle and ring
fingers.

X ray
Skull Spine Pelvis Long bones
• Large skull vault
• Frontal bossing
• Small & funnel shaped
foramen magnum
• Bullet shaped
vertebrae
• Posterior scalloping
vertebrae angular
kyposes &
dorsolumbar spine
• Spinal canal stenosis
• Champagne glass
pelvis
• Square shaped iliac
blades (tomb stone
iliac blades)
• Horizontal iliac blades
• Metaphyses are flared
& v shaped (chevron
sign)
• Humerus & femur are
short & widened

Bullet shaped vertebral bodies in
achondroplasia

Champagne glass pelvis in achondroplasia

Tombstone iliac blades

Horizontal acetabular roof

Chevron sign  inverted V shaped
metaphysis

Tomb stone shaped iliac
bones
Horizontal acetabular roof
Short femur
Chevron sign

Short femur

Posterior scalloping
Bullet shaped
vertebrae

Scoliosis

Scoliosis
• Any lateral curvature of spine > 10 * in coronal plane

Apex vertebrae
Modt rotated vertebrae in the curve & most deviated
vertebrae from central vertical axis

Kyphoscoliosis Scoliosis + increased kyphosis (normal kyphosis in
thoracic spine is 20-40*)
Lordoscoliosis Scoliosis +decreased kyphosis (<20*)

Functional scoliosis Structural scoliosis
Curve with no structural component & corrects on
side bending x rays
A segment of spine with fixed alteral curve & donot
correct on side bending x rays

Infantile scoliosis Juvenile scoliosis Adolescent scoliosis
<3 years 3-10 years >10 years

Apex curvature measurement
Cobbs lippman method Risser ferguson method
More common

Management
<20* No rx
20-40* Milwaukee braces
>40 * Surgery (Harrington rod / dwyer procedure)

Milwaukee brace in correction of scoliosis

Harrington rod in correction of scoliosis

Osteomalacia

Osteomalacia
• Generalised osteopenia
• >30 % bone mineral loss visible on x ray
• Thinned cortex
• Corsening of trabeculae
• Pseudo#
• Increment #
• Umbao zonens
• Milkman #
• Loosers zone
• Biconcave / codfish vertebrae
• Deformities
• Inferior displacement of sacrum
• Triradiate pelvis
• Protrusio acetabuli
• Femur & tibial bowing
• # deformities

Tri radiate pelvis

Codfish vertebrae in osteomalacia

Pseudofractures in osteomalacia
• b/l symmetrical
• Perpendicular to cortex
• MC sites
• Femoral neck
• Medial femoral cortex
• Ischiopubic ramus
• Axillary border of scapula
• Proximal ulna
• Distal ulna
• Absent callus
• Mild sclerosis

Rickets
• Widened growth plate (earliest specific x ray sign)
• Cupping splaying & fraying of metaphysis (paint brush metaphysis)
• Absent zone of provisional calcification (earliest sign on x ray)
• Bow shaped legs
• Pigeon shaped chest
• Rachitic rosary
• Craniotabes
• Protrusio acetabuli & triradiate pelvis
• Reappearance of dense white zone of provisional calcification is the first sign of healing
rickets
• Windswept deformity

Rachitic rosary beaded appearance of
anterior end of ribs

Tumour related hypophosphatemic rickets
• Oncogenic hypophosphatemic osteomalacia
• NF
• Fibrous dysplasia
• Osteoblastoma
• Hemiangiopericytoma
• Tumours release FGF23  phosphaturia

Scurvy
• Dense white line of provisional
calcification (white line of frenkel)
• Ring epiphysis (wimberger sign)
• Pelkan spurs
• Corner or angle sign (irregular
metaphyseal corner)
• Trummerfield zone (scorbutic zone)
• Area of radlucency above whiteline
• Subperiosteal haemorrhage
All signs of scurvy disappear except white
line of frenkel

Subperiosteal hemorrhage
• in distal femur and tibia and proximal humerus,
• causing excruciating tenderness pain near the large joints.
• The child lies still to minimize pain or minimally move the affected
limb (pseudoparalysis) - (Frogs like posture is attained by child)

Generalised osteopenia  earliest sign
Normal functioning osteoclast

• periosteal reaction due to subperiosteal haemorrhage
• haemarthrosis
• Wimberger's ring sign:
• circular, opaque radiologic shadow surrounding epiphyseal centers of ossification,
which may result from bleeding
• Frankel's line:
• dense zone of provisional calcification
• Trümmerfeld zone:
• lucent metaphyseal band underlying Frankel's line
• Pelken spur: metaphyseal spurs which result in cupping of the metaphysi

• scorbutic rosary:
• expansion of the costochondral junctions
• may relate to fracturing of the zone of provisional calcification during normal
respiration
• In Rickets—Rosary is Round and non-tender, and in Scurvy it is Sharp and
tender

Sickle cell anemia
• Expansion of marrow cavity (hair on
end appearance)
• Thinned cortex
• Coarsening of trabecular pattern
• H shaped vertebrae / Lincoln log
vertebrae
• Metaphysis infarcts
• AVN of humerus & femur
• Salmonella osteomyelitis (b/l symmetric
diaphyseal prominent involucrum
formation )
• Erlenmayer flask deformity

Metaphyseal infarcts

H shaped vertebrae / Lincoln log vertebrae

H shaped vertebrae
Iclogging of blood vessels by
sickled RBC  end plate infarction

Erlenmayer flask deformity is also seen in
osteopetrosis
• Also seen in
• Thalassemia
• Sickle cell anemia
• Pyle’s disease
(Craniometaphyseal
deformity )
• Diaphyseal aclasis
• Osteodysplasty
• Gaucher’s
• Nieman pick disease

Erlenmayer flask deformity in osteopetrosis

Pyle disease
• AR
• Metaphyseal dysplasia
• Genu valgum
• Erlenmayer flask

hyperparathyroidism

Primary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism
Skeletal features only Renal osteodystrophy  skeletal
features
Skeletal changes less florid More florid
Sclerosis rare Common
Brown tumour  common less common
Chondrocalcinosis common Less common
Soft tissue & vascular calcification
less common
More common

Radiological features of primary
hyperparathyroidism
• Subperiosteal resorption of phalanges
• Irregular diffuse rarefaction of bone
• Salt & pepper appearance of skull
• Multiple cyst in pelvis & other bones
• Brown tumour

Subperiosteal resorption of bone • Earliest & best seen at radial aspect of middle
phalanges of middle & index finger
• Other sites are lamina dura of teeth / superior &
inferior margins of ribs ,medial aspects of proximal
humerus & tibia
Trabecular bone resorption • Salt and pepper skull
• Loss of definition of outer table & inner table
Other bone resorption • intracortical / endosteal/ subphyseal /
subligamentous
Brown tumour • Represent repeated haemorrhages with in bone
• Lytic expansile lesion
• Mc site  mandible (mc)/ clavicle /ribs/ tubular
bones
Chondrocalcinosis • Calcification of hyaline / fibrocartilage
• CPPD deposition
• Knee (mc) aslo affect symphysis pubis ,trainaglar
cartilage of wrsit

Subperiosteal resorption of phalanges in
primary hyperaparathyroidism
• Earliest & best seen at
radial aspect of middle
phalanges of middle &
index finger

• X-ray findings of
hyperparathyroidism:
• Subperiosteal resorption of the
terminal phalanx
• Pathognomonic

Salt and pepper skull appearance
• hyperparathyroidism.
• It occurs due to resorption of
the trabecular bone in the
skull and replacement of the
reabsorbed bone by a newly
formed connective tissue
causing loss of integrity in the
shape of skull bones

Salt & pepper appearance of skull in primary
hyperaparathyroidism

Loss of lamina dura in primary
hyperaparathyroidism

Multiple cyst in pelvis & other bones in
primary hyperaparathyroidism

Brown tumour/ osteitis fibrosa cystica
/vonrecklinghausen disease of bone
• Represent repeated haemorrhages with in bone
• Lytic expansile lesion
• Mc site  mandible (mc)/ clavicle /ribs/ tubular bones

Brown tumour in hyperparathyroidism

Brown tumour in hyperparathyroidism
• a. Brown tumors are tumors of bone that arise in
settings of excess osteoclast activity, such as
hyperparathyroidism, and consist of fibrous tissue,
woven bone and supporting vasculature, but no
matrix.
• b. They are radiolucent on x-ray. The osteoclasts
consume the trabecular bone that osteoblasts lay
down and this front of reparative bone deposition
followed by addition resorption can expand beyond
the usual shape of the bone, involving the
periosteum and causing bone pain.
• c. The characteristic brown coloration results from
hemosiderin deposition into the osteolytic cysts. Also
characteristic of giant cell tumors of the bone.

Chondrocalcinosis
• Calcification of hyaline /
fibrocartilage
• CPPD deposition
• Knee (mc) aslo affect symphysis
pubis ,trainaglar cartilage of wrsit

• Rugger jersey spine
• Patients with renal
failure with 2* HPT
• Combination of
osteomalcia
osteosclerosis & 2*
Hyperparathyroidism
• Renal osteo dystrophy

Sestamibi radionucleotides a scan for
parathyroid adenoma

Cod fish spine
Intervertebral disk becomes
ballooned as they indent soft
vertebral bodies forming the
'Cod Fish spine

Cod fish appaearance is also seen in

Pagets disease of bone
Osteolytic (hot phase) Mixed (indeterminate) Dense (sclerotic)
• Blade of grass / flame sign
• Osteoporosis circumscripta of
frontal bone
• Jigsaw / mosaic pattern
• Cotton wool skull
• Picture frame vertebrae
• Tamo shatter hat
• Ivory vertebrae

Osteoporosis circumscripta in lytic phase of
pagets ds

Blade of grass sign in lytic phase of pagets ds

Cotton wool appearance in mixed lytic phase

Tam o shanter sign in sclerotic phase

Picture frame vertebrae in mixed stage
Ivory vertebrae in sclerotic stage
of pagets ds

Eosinophilic granuloma

Eosinophilic granuloma
• Lytic lesion in skull & lytic bones
• Skull  50 % (mc site in children) followed by spine
• Pelvis 23%
• Femur -->17 %
• Ribs  8 %most common site in adult

Manifestations of eosinophilic granuloma
Skull Mandible Spine Long bones
• Solitary lytic punched
out lesions
• Hole with in whole
• Bevelled edges
• Geographical skull
• Button sequestrate
• Erosison of almina
dura flating tooth
appearance
Vertebra plana Permeative & aggressive
appearing lesions

Geographical skull in eosinophilc granuloma
Hole with in a hole
appearance / bevelled
edgesTONY SCARIA 2010 KMC

Vertebra plana in eosinophilc granuloma
Vertebra plana

Type I (hurler syndrome) Type IV (morquio syndrome)
• Macrocephaly with narrowed skull base
• J shaped sella tursica
• Pointed proximal ends of metcarpals
• Anteroinferior beaking of vertebral bodies
• Normal height of vertebra
• Oar / paddle like ribs(expended anterior ends of
ribs)
• Macrocephaly with narrowed skull base
• J shaped sella tursica
• Pointed proximal ends of metcarpals
• Central tongue like beaking of vertebral bodies
• Platysondyly  decreased height of vertebrae

Hurler syndrome
J shaped sella
Pointed metacarpal
Broadened anterior end of ribs  oar shaped

Anteroinferior beaking of vertebrae

• Central tongue like beaking of vertebral bodies
• Platysondyly  decreased height of vertebrae
Morquio syndrome

Wine glass pelvis  MPS

Mucopolysaccharidoses
• Bullet shaped phalanges
• J shaped sella

Osteogenesis imperfecta

Osteogenesis imperfecta
• Lobsteins disease
• CF
• Osteoporosis
• Blue sclera
• Abnormal dentine
• Premature osteosclerosis

Sillence classification of osteogenesis
imperfecta

Type I Type II Type III Type Iv
Inheritance AD AR AD/ AR AD
Most common Most lethal
Blue sclera Blue sclera Blue sclera Normal

Blue sclera
Absent in type IV OI

Radiological features of OI
• Diffuse decrease in bone density
• Multiple diphyseal #with excessive callus formation (in battered baby syndrome  multiple metaphyseal #)
• Bowed deformed bones
• Skull  wormian bones

Bowed deformed bones

Wormian bones in skull in OI

Arthritis

OA
• Mc joint ds in hand  1st CMC
• PIPbouchards node
• DIP herbendens nodes
• Asymmetric
• Nonuniform joint space loss
• Osteophytes
• Subchondral sclerosis
• Subchondral cysts
• Intrarticular loose bodies
• Joint subluxation & deformities
• Vacuum sign
• N2 deposition in IVD
Sparing of MP joint

Erosive OA
• Inflammatory
variety of OA
• Typical sea gull
wing in DIP

Vacuum sign d/t accumulation of N2 gas

Rheumatoid arthritis
• Mc joints in – MCP & PIP
• Sparing of DIP
• b/l symmetrical
• Periarticular soft tissue swelling  earliest X ray feature
• Periarticular osteopenia
• Uniform joint space loss
• Marginal articular erosions
• Deformities
• Boutennaires
• Swan neck deformity
• Z deformity
• Hitchikers thumb

Boutennaire deformity of thumb

Psoriatic arthritis
• Mc joint in hands  DIP
• Asymmetrical
• Soft tissue swelling
• Normal bone density
• Widened joint space
• Marginal articular erosions (mouse ear erosions)
• Pencil in cup deformity

Mouse ear
erosions

Tufting of distal phalanx  psoriatic
arthropathy

Mouse eaten appearance in gouty arthritis
• Erosions with overhanging
margins
• Chondrocalcinosis
• MC joint 1st MTP

Big intercondylar notch in hemophilic
arthropathy

Meniscal cartilage calcification in a patient
with pseudogout
• CPPD
• Chondrocalcinosis
• Mc in knee joint

AS
• b/l symmetrical sacroilitis
• In lower 2/3rd of joint
• Iliac side more involved (initially)
• Earliest change can be detected by MRI
• Best investigation is CEMRI

Enthesitis  inflammation @ site of insertion of
ligament
• Romanas sign
• Shiny corner sign
• Squaring of vertebra  bamboo spine

Romanas sign
• d/t inflammation at site of
insertion of ligament

Shiny corner sign in Ankylosing Spondylitis

Squaring of vertebrae

Tram track calcification in AS
3 parallel lines appear d/t calcification &
ossification of
• Interspinous
• Superspinous ligament

Dagger sign in AS
• Dense line caused
by ossification of
supraspinous
ligament &
interspinous
ligament

Andersson lesion
• Fracture occurring with in
Bamboos spine 
psudoarthrosis (bcz of no
helaing)

Scleroderma
• CREST
• Calcinosis cutis
• Acroosteolyiss of
distal phalanx are
pathognomonic
Calcinosis cutis
Acro osteolysis

Scleroderma

Neuropathic arthropathy
Atrophic type Hypertrophic type
Licked candy stick appearance 6 D
• Distension of joint
• Destruction
• Debris
• Dislocation
• Deformity
• Density of bone increased

Licked candy stick appearance is also seen in

Licked candy stick appearance

Dribbling candle wax sign
Melorheostosis:TONY SCARIA 2010 KMC

Melorheostosis:
• Melorheostosis (Greek, “flowing hyperostosis”) may occur
sporadically or follow a pattern consistent with an autosomal
recessive disorder.
• The major manifestation is progressive linear hyperostosis in one or
more bones of one limb, usually a lower extremity.
• The name comes from the radiographic appearance of the involved bone,
which resembles melted wax that has dripped down a candle.

• Symptoms appear during childhood as pain or stiffness in the area of sclerotic bone.
• There may be associated ectopic soft tissue masses, composed of cartilage or osseous tissue, and
skin changes overlying the involved bone, consisting of scleroderma-like areas and hypertrichosis.
• The disease does not progress in adults, but pain and stiffness may persist.
• ◘ Laboratory tests are unremarkable.
• ◘ No specific etiology is known.
• ◘ There is no specific treatment.
• ◘ Surgical interventions to correct contractures are often unsuccessful.

Osteoporosis

Radiological features of osteoporosis
• X ray:
• poor test for osteoporosis. Its evident on x ray only when 30% of bone
loss is there. cod fish mouth vertebra. Singh and Maini index is the
index used for osteoporosis based on x ray of hip joint.

Singh and Maini index is the index used for
osteoporosis based on x ray of hip joint

X ray
• Loss of height of vertebral body
• Cod fish appearance

• Dexa scan:
• Investigation of choice.
• Gold standard for diagnosis
• Dual energy absorption scan
• Value is given as T-score (most commonly used, compares BMD with 25 year
male, lumbar spine BMD) or Z score (age and sex matched)

Dual energy X-ray absorptiometry (DEXA)
• gold standard for the diagnosis of osteoporosis

T score in DEXA

For assessment of osteoporosis
• Three sites choosen:
• Hip, spine, wrist.
• Value of one site only give bone mineral density (BMD) and
prediction fracture of that site only

Osteopetrosis

Sandwich spine is seen in osteopetrosis

Bone in bone appaearance

Fluorosis

Calcification of posterior longitudinal
ligament

Calcification of inter osseous membrane in
fluorosis

• Fluorine stimulates osteoblastic activity; fluoroapatite crystals are
laid down in bone and these are usually resistant to osteoclastic
resorption. This causes calcium retention implied mineralization and
secondary hyperparathyroidism.

Miscellaneous

Klippel – feil syndrome
Congenital fused
cervical vertebrae

Klippel fail syndrome
• Triad
• Low hair line
• Shot neck
• Limited neck movement

Calcification of intervertebral disc
• Alkaptonuria

• Rugger jersey spine
• Renal osteo dystrophy

H shaped spine
• Sickle cell anemia
• microvascular endplate infarction central depression

Bamboo spine  ankyloses spondylitis

• Butterfly vertebrae alagille syndrome
• Alagille syndrome
• Butterfly vertebrae
• Cardiac defect
• Dysmorphic facies
• Embryotoxon (posterior)

Butterfly vertebrae in alagille syndrome

Flowing candle wax appearance in DISH

DISH (diffuse idiopathic skeletal hyperostosis)
• DISH / forestiers disease
• Flowing ossifications of bone
involving 4 or more
contiguous vertebrae

Polka dot sign  haemangioma of vertebral
bodies

Vertebral haemangioma
Corduroy sign
Corduroy sign - prominent vertical trabeculations in vertebra -
hemangioma , thallassemia

Sabre tibia
• Congenital syphilis
• Pagets disease
• Osteogenesis imperfecta

metaphyseal band
Dense metaphyseal band Lucent metaphyseal band
• Hypothyroidism
• Osteopetrosis
• Lead poisoning
• Hypervitaminosis D
• Healing rickets
• Scurvy
• Leukemia
• Metaphyseal #

Dense metaphyseal band

Multiple translucent transverse metaphyseal
bands  growth arrest line in leukemia

Epiphyseal widening Rickets
Epiphyseal dysgenesis Hypothyroidism
Epiphysis enlargement Juvenile rheumatoid arthritis

Scottish dog appearance Normal
Scottish dog collar Spondylolysis
Beheaded Scottish dog spondylolisthesis

Scottish dog

Inverted napoleon hat sign in
spondylolisthesis

Cupping & fraying are also seen in
• Hypophospahtasia
• Rickets
• Metaphyseal dysostosis

Congenital syphilis
• Sabre tibia
• Wimbergers sign
• Cluttons joint (swollen knee joint)

Wimbergers sign
• bilateral focal destruction of the medial
aspect, proximal tibial metaphyses;
• pathognomonic for congenital syphilis

• Wimberger's Ring Sign-
• denser white line of calcification
encircling the osteoporotic
epiphyses
• in scurvy

Celery stalk metaphysis
• Celery stalk metaphysis refers to a
plain film appearance of the
metaphyses in a number of conditions
characterised by longitudinally aligned
linear bands of sclerosis. They are seen
in:
• congenital infections
• congenital rubella
• congenital syphilis
• congenital cytomegalovirus (CMV)

Bone tumours

Epiphyseal
• Chondroblastoma
b/w 10-25 yrs
• GCT b/w 20-40 years
after skeletal
maturity
• clear cell
chondrosarcoma
Diaphyseal
• Adamantinoma
• Osteoid osteoma
• Lymphoma
• Ewings sarcoma
• Multiple myeloma
Meatapshysis
• OSTEOSARCOMA
• CHONDROSARCOMA
• SIMPLE BONE CYST
• ANEURYSMAL BONE
CYST
• Fibrous cortical
defect

Simple bone cyst/ solitary/ unicameral
• Before the age of 20 years
• Mc site is proximal humerus followed by proximal femur
• Expansile
• Metaphyseal
• Fallen fragment sign cortical fragment of
pathological # settles in most dependant position
• Hinged fragment sign  fractured fragment
doesnot separate from adjacent cortex
Hinged fragment sign 
fractured fragment doesnot
separate from adjacent cortexTONY SCARIA 2010 KMC

Simple bone cyst
Mc site  proximal humerus 2nd most common site  femur

Hinged fragment sign

Aneurysmal bone cyst
• In < 20 yrs of age
• Mc sites
• Femur tibia followed by spine (arch of
vertebrae)
• Eccentric
• Metaphyseal
• Expansile
• Lytic
• Erosion of overlying cortex
• On MRI  multiple air fluid level

Giant cell tumor
• Age 20-40 years
• F>>M
• Common sites
• Distal femur >> proximal tibia >>distal radius
• Epiphyseal
• Eccentric
• Expansile lytic
• Overlying cortex undergo resorption
• Soap bubble appearance

GCT in distal end of radius

Soap bubble appearance in GCT

ABC GCT
Age <20 yrs Age 20-40 years (after epiphyseal closure)
Metaphyseal Epiphyseal

Fibrous dysplasia
• Developmental disorder
most commonly in early
adolescent
• Mc site are ribs femur
tibia
• Metaphyseal
• Radiolucent
• Sclerotic margins
• Ground glass appearance
• Cortical thinning
• Shepherd crroks deformity
• Ground glass appearance
• Shepherd crooks
deformity

Osteochondroma
• Mc benign tumour
• Teenagers & young adults
Metaphyseal / diaphyseal
Pedunculated with bony stalk & covered by
cartilaginous cap
Medullary canal is continuous with medullary
canal of normal bone

Osteoid osteoma
• 5 – 25 years
• Diaphysis of long bones  femur & tibia
• Radiolucent nidus &
sclerotic rim

Osteosarcoma
• Mc primary malignant tumour
• Metaphysis of long tubular bones
• Mc site is distal femur followed
proximal tibia
• Metaphyseal
• Eccentric
• Bine formation in matrix
• Sunray appearance e
• Codmans triangle
• Onion peel appearance (mc & characteristic of
ewings sarcoma)

Codmans triangle
Sunray appearance e

Ewings sarcoma
• 5-15 years
• Diaphysis of long bones
•
• Diaphyseal
• Onion skin periosteal reaction
‘sunray appearance &
codmans triangle (MC in
osteosarcoma)

Enchondroma

Ollier syndrome  multiple
enchondromatosis

Multiple enchondroma + haemangioma 
maffucis syndrome

Driven snow appearance ein pindorg tumour

Pulsatile bony metastasis
• Thyroid malignancy
• RCC
• Melanoma
• Pheochromocytoma
Osteoblastic bony metastasis Osteolytic
Prostate (MC) • Thyroid
• Breast

Wormian bones
Bony ossicles with in skull sutures
MC site  lambdoid suture
If more than 10 in number & more than 6*4mm in size 
abnormal

Os inca
• Large single wormian bone
• @ junction of lambdoid & sagittal suture

Wormian bones are also seen in
• cleidocranial dysplasia,
• congenital hypothyroidism,
• pachydermoperiostosis,
• Menke’s syndrome
• trisomies.

Wormian bone

J shaped sella
• Chronic hydrocephalus
• Optic glioma, Osteogenesis
imperfecta
• Neurofibromatosis
• Mucopolysaccharidosis
• Achondroplasia
• Normal varian
d/t resorption of anterior margin of
tuberculum sellae j shaped

Short 4th metacarpal /metatarsal
• Post traumatic
• Turners syndorme
• Pseudohypoparathyroidism
• Pseudopseudohypoparathyroidism
• Basal cell nevus syndrome  gorlin
syndrome
• Post infection from sickle cell
anemia
• Hereditary multiple exostosis

Vertebra plana
• Vertebra plana is also seen in
• Eosinophilic granuloma
• Calves ds (osteochondritis of vertebrae)
• Ewings sarcoma
• Metastasis
• leukemia

Ivory vertebrae
• Seen in
• Pagets disease
• Treated TB
• Lymphoma
• Osteoblastic metastasis

Loosers zone
• these are areas of unmineralized woven bone occurring at sites of
mechanical stress or nutrient vessel entry (pulsations of the arteries)

Loosers zone- causes
• Osteomalacia/rickets (characteristically)
• Osteogenesis dysplasia
• Organic renal disease (1%)
• Osteoporosis
• Osteopetrosis
• Paget’s disease
• Polyostotic fibrous dysplasaia
• Post operative
• Renal tubular dysfunction
• Rickets
• Radiation ostitis
• Fibrous dysplasia
• Congenital hypophosphatasia
• Congenital hyperphosphatasia
• Vitamin d deficiency
• Neurofibromatosis
• Vitamin a intoxication
• Cadmium poisoning
O P R S
Osteomalacia/ricke
ts
(characteristically)
Osteogenesis
dysplasia
Organic renal
disease (1%)
Osteoporosis
Osteopetrosis
Paget’s disease
Polyostotic fibrous
dysplasaia
Post operative
Renal tubular
dysfunction
Rickets
Radiation ostitis
Stress #
Steroid therapy

Odontoid view to visualise C1 C2

Hangmanns fracture

Jefferson #

• Spinal TB  diagnosed by CT guided biopsy

• On MRI the differential diagnosis of spinal cord edema is -
Myelomalacia (spinal cord softening)

• Spinal cord edema is also seen in spinal cord infarctions

• Traumatic paraplegia diagnosed by MRI

Scalloping of vertebrae
• Seen on lateral view
• Posterior scalloping (more common) than anterior scalloping

Posterior vertebral scalloping

Anterior vertebral scalloping

Causes of vertebral scalloping
Posterior scalloping (more common) Anterior scalloping
• achondroplasia
• intraspinal masses, such as
 spinal astrocytoma
 ependymoma
 spinal schwannoma
 neurofibroma as seen in neurofibromatosis type 1
• neurofibromatosis type 1
• Marfan disease
• Ehlers-Danlos disease
• osteogenesis imperfecta tarda
• mucopolysaccharidoses
• acromegaly
• retroperitoneal lymphadenopathy
 chronic leukaemia and lymphoma
 Tuberculosis
 many others
• abdominal aortic aneurysm
• Down syndrome
• histiocytosis X

Musculoskeletal radiology findings in skeletal dysplasias and metabolic bone diseases

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