Paleopathological Conditions Flashcards
Learning the basics and how to identify the conditions on bone
Osteitis
What is it?
Inflammation of the cortical bone
What does it look like?
Bone may be hypertrophic & heavy
*Appears radiopaque (white) on radiographs
Osteomyelitis
What is it?
Inflammation of the medullary cavity
What does it look like?
Must have sequestrum (dead bone), involucrum (sheath of new bone) and cloaca(e)
PNB (Periosteal New Bone)
What is it?
Inflammation of the periosteum
What does it look like?
Woven (grey/brown in colour, disoriganized) or Lamellar (normal colour, striated)
Scurvy
What is it?
Lack of vitamin C = defective collagen (can stop bone growth and weaken connective tissue around teeth)
What does it look like?
- Porosity and new bone in areas of muscle attachment on SCAPULAE & SKULL
- PNB on long bones
Radiographical Signs of Scurvy
1) White Line of Frenkel – dense white line at metaphysis
2) Trummelfeld’s Zone – line of decreased radio-density proximal or distal to (WLF)
3) Pelkan’s spurs – small spurs of bone protruding laterally and medially from WLF
4) Wimberger’s ring – dense calcification around ephiphyses
Rickets
What is it?
Lack of vitamin D = ineffective mineralization resulting in ‘soft’ weak bones
What does it look like?
PRIMARY…
- Metaphyses appear cupped and flared
- Rachitic rosary = nodular prominences at costochondral junction of ribs
- Delayed closure of fontanelles
SECONDARY…
- Bowing deformities
- Medial tilting of distal tibiae
- Coxa vara (more acute angle) of femoral neck
- Flattening of cranial bones
Radiographical Signs of Rickets
- Metaphyseal margin irregular & frayed
- Metaphysis widened and cupped
- General osteopenia of cortex
- Loss of cortico-medullary distinction
- Coarsened trabeculae
Osteomalacia
What is it?
- Lack of vitamin D = ineffective mineralization resulting in ‘soft’ weak bones
- Considered adult Rickets
What does it look like?
Less obvious skeletal changes than Rickets…
- Straightening of ribs
- Sternum displaced anteriorly
- Scoliosis (M-L) or kyphosis (A-P) curvature may develop
- Lower lumbar vertebrae and acetabulae can protrude into pelvic inlet
- Looser’s zones = large seams of osteoid which appear as pseudo-fractures radiographically
Osteoporosis
What is it?
More bone removed per remodeling unit due to increased osteoclastic and decreased osteoblastic activity
What does it look like?
- Lower weight of bone
- Occurs along endocortical surface, creating a trabecular structure at the margins of the medullary cavity
- Typically, would see fracture patterns (likely hip, Colle’s and vertebral)
Paget’s Disease
What is it?
Unknown cause, mostly affects older individuals
Rapid disorganized remodeling
What does it look like?
- Typically involves the skull, vertebrae, femur or tibia
- Bones appear hypertrophic, but are structurally weak and prone to bend and fracture
- In cross section, cortical bone has ‘honeycomb’ appearance with lots of gaps
- Cortical surfaces have porous, dense woven bone
Radiographical Signs of Paget’s Disease
- Visible in lytic phase: Flame sign = area of v-shaped translucency that extends in distal to proximal direction
- Visible in mixed/sclerotic phase: thick radio-opaque cortex, cotton wool skull, picture frame vertebra, ivory vertebra, Looser’s zones
Three Phases of Paget’s Disease
1) Lytic (increased OC activity)
2) Mixed (increased OC and OB activity)
3) Sclerotic (OB increased, OC decreased)
Porotic Hyperostosis
What is it?
Caused by expansion of the diploe and thinning of the outer table
What does it look like?
Porosity and pitting of the outer table of skull
*Radiographical signs = ‘hair on end’ appearance
Cribra Orbitalia
Similar porous, pitted appearance to Porotic Hyperostosis, but primarily isolated to orbital roof
Dental Enamel Hypoplasia
What is it?
Caused by stress-induced disruption of amelogenesis - the process that produces enamel
What does it look like?
Bands or pits on dental enamel
Interglobular Dentine
What is it?
Poorly mineralized dentine arising from unfused calcospherites in vitamin D/Ca deficient individuals
What does it look like?
Dark blobs of dentine seen in cross section of tooth under a microscope
Osteosarcoma (primary benign)
An outgrowth of bone, forms out of growth plate but can be seen on surface of bone
Can appear ‘stalked’ or ‘pinched’
Osteosarcoma (primary malignant)
What is it?
Tumor that metastasizes (spreads to other areas of the body)
What does it look like?
- Arises directly from cortex, often near metaphysis
- Primarily affects long bones
- More disorganised and spiculed than benign osteosarcomas
Radiographical Signs of Malignant Osteosarcomas
- Sunburst appearance and/or Codman’s triangle (represents aggressive, fast-forming periostitis)
- Destruction of medullary cavity
Osteosarcoma (secondary malignant)
What does it look like?
- Lesions can be lytic (holes with ‘chewed’ edges), sclerotic (new bone formation, sometimes ‘sunburst’) or mixed
- Multiple Myeloma – increased OC activity, decreased OB activity (lytic), lots of little holes on scapula, skull, pelvis, vertebrae and ribs
*Sclerotic lesions appear radiopaque
Lumbarisation
First sacral vertebra does not fuse with the rest of sacrum (less common)
Sacralisation
Fifth lumbar vertebra fuses with sacrum
Scoliosis
- Lateral curvature of the spine
- Vertebrae appear asymmetrical or wedge-shaped
- Curved spinous processes, short and fat transverse processes on convex side, long and thin on concave side
Spina Bifida
What is it?
- Malformations of the neural canal (neural tube defect, 4th week gestation)
- In serious cases, spinal cord and nerves protrude through skin (spina bifida cystica)
What does it look like?
Posterior arch of neural canal does not fuse, most often in sacral and lumbar vertebrae
