Radiographic signs: Periosteal rxn Flashcards
Pathological lifting of the periosteum away from bone due to stimulation.
PEriosteal rxn
Stimulants of periosteal rxn
Extension of blood, pus or tumor
Hyperemia
Inflammation
Edema
Which layer of periosteum is involved in periosteum rxn
Inner cambium
T/F: We don’t see the periosteum in normal or abnormal conditions. However we see the bone produced.
True
3 types of periosteal rxn pattern
Solid
Laminated
Spiculated
PEriosteal rxn:
Single layer of bone layed longitudinally parallel to cortex
Appears smooth, wavy or chunking
Slow growing/Benign
Local or diffuse (tubular bones)
Responds to insult or irritation
Solid
Causes of solid periosteal rxn
Local: Infection Benign bone neplasm Eosinophillic granuloma Fracture healing
Diffuse:
Hypertrophic Osteoarthropathy
Variscosities (lower extremities
Example of Local benign bone neoplasm that is a very localized solid periosteal rxn.
Very dense area of cortical thickening
Very common classic bone forming bone tumor
Osteoid osteoma-bone tumor from osteoblast
Causes of solid periosteal rxn:
Local
Stimulated by chronic inflammation
Produced by granulation tissue
Cause of compression fx in spine
Eosinophillic granuloma
Causes of solid periosteal rxn:
Diffuse excess of bone and joint growth
Hypertrophic Osteoarthropathy
Causes of periosteal rxn:
Venous stasis of blood leading to bone pain that causes periostitis in the tibia, fibula and metatarsals
Variscosities
CAuses of periosteal rxn:
Callous formation helps produce new collar of new bone
Fracture healing
Direct stimulus from an underlying bone lesion (intrinsic); mc fracture
healing, infection, and benign bone neoplasm
Localized periosteal rxn
Systemic diseases and the periosteum is reacting; mc hypertrophic
osteoarthropathy
Wide spread periosteal rxn
If more than 1 tubular bone shows a periosteal reaction, is it local or diffuse?
Diffuse
Cause of Diffuse SOLID Perioteal rxn:
Clinical syndrome consisting digital clubbing
Skin thickening and
Periosteum
3-5% of cases
Radiographically diffuse widespread symmetrical periostitis involving DIAPHYSIS AND METAPHYSES
Primary hypertrophic osteoarthropathy
Cause of Diffuse SOLID Perioteal rxn:
Clinical triad of digital clubbong, periositis, synovitis
Found in bronchogenic carcinoma patients
95% of cases
Secondary hypertrophic osteoarthropathy
Cause of Diffuse SOLID Perioteal rxn:
Usually seen after tx for hyperthyroidism when pt are euthyroid or hypothyroid.
Pt shows exopthalmos, digital clubbing pretibial myxedema and periostitis
Thyroid acropachy
Cause of Diffuse SOLID Perioteal rxn:
Uncommon disorder of infancy usually middle of the first year characterized by sudden onset of fever, hyperirratibility and swelling especially over the mandible!
Infantile cortical hyperostosis AKA Caffey’s disease
Cause of Diffuse SOLID Perioteal rxn:
Acute overdose of vitamin A associated with nausea, vomitting, headache and irratibility.
Periostitis involving tubular bones especially the ulna and metatarsals
NOT in mandible
Hypervitaminosis A
Cause of Diffuse SOLID Perioteal rxn:
Periostitis occurs in children related to subperiosteal bleeding
Capillary fragility related to hypovitaminosis C
Gum bleeding
Scurvy
Cause of Diffuse SOLID Perioteal rxn:
Mutliple areas of solid periosteal new bone associated with multiple fractures at different stages of healing
Battered children
Cause of Diffuse SOLID Perioteal rxn:
Excessive growth hormone production stimulating solid periosteal bone formation
Acromegaly
Cause of Diffuse SOLID Perioteal rxn:
Multiple areas of bone desrtuction associated with adjacent periostitis
Leukemia
Cause of Diffuse SOLID Perioteal rxn:
Young children under two years show normal physiological new bone formation
Normal
Periosteal rxn:
Demonstrates multiple concentric parallel layers of new bone adjacent to the cortex
May transform to solid but never form full cortex
Mostly in diaphysis
Laminated
Causes of laminated rxn
Ewing (Classic cause)
Eosiniophilic granuloma
Osteomyelitis
leukemia
Top 5 primary malignant bone cancer?
MOCEF
Multiple myeloma
Osteosarcoma
Chondrosarcoma
Ewings
Fibrosarcoma
T/F: Osteomyelitis can produces any periosteal rxn
True
Periosteal rxn:
Most aggressive
Fine, linear spicules oriented perpendicular to cortex
Parallel or radiating
Rapidly growing lesions(5-6 weeks)
Characteristic of Osteomasarcoma
Spiculated AKA
perpendicular, brushed whiskers, hair-on-end, and sunburst
Cause of spiculated periosteal rxn
Osteomyelitis
Osteosarcoma
Ewings
chondrosarcoma
Fibrosarcoma
Lymphoma (Non-Hodgkin)
Leukemia
Periosteal rxn subset that can be in any of the three types.
Is typically with the aggressive rxn
Typicall at the ends/edge of periosteal rxn
@diaphysis
Codman’s angle, periosteal cuff, or buttress
