Diffuse Osteosclerosis - Onuwaje

8/22/2019 Diffuse Osteosclerosis - Onuwaje

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Give an account of the

radiological differential diagnoses

of a patient who has diffuseosteosclerosis


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Outline

Introduction

Differential diagnoses

Imaging modalities Radiological characteristics


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Introduction

Diffuse osteosclerosis is diffuse increase

bone density seen as

An overall whiteness (sclerosis) to all or

most of the bones.

Diffuse loss of visualization of normal

trabecular network.

Loss of corticomedullary junction.


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Possible causes 5MS To PRoOF

1.Metastasis

2. Myelofibrosis

3. Mastocytosis

4. Melorheostosis

5. Metabolic(hypervit D, fluorosis, hypothyroidism,phosphorous poison)

6. Sickle cell amaemia

7. Tuberous sclerosis

8. Pyknodysostosis

9. Renal osteodystrophy

10.Osteopetrosis

11.Fluorosis


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Imaging modalities

Plane Radiographs

CT

MRI Radionuclide studies

Angiography

USS


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(A)Metastasis

Malignant bone lesion with primary focus

outside the bone.

Major cause of bone malignancy

Mainly from prostate stomach and

carcinoid tumours.

c/f occult, vague pains, swellings, path #


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Plain radiograph

Shows diffuse osteoblastic lesion thatproduces dense and often wellcircumscribed area of increased

radiopacity affecting majorly the spine,pelvis and ribs then end of humerus andfemor, and less often the skull.

Multiplicity of lesions

Fractures may be seen though notcommon


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CT shows similar areas of increased bonedensity and distribution but with a moredetailed degree of affectation.

Very early bony lesion are detectable, Very small calcifications and soft tissue

affectations are delineated.

MRI ll show similar lesions as with CT butbetter soft tissue resolution. Can revealprimary focus.


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(B)Myelofibrosis(myeloid

metaplasia)

Has intimate relationship withmyelosclerosis, polycythaemia rubra veraand CML.

Typical pt is a middle age or elderly adult. Presents with fatique,

hepatosplenomegally and anaemia.

Mainly affecting the red marrow areas espthe pelvis. The whole skeleton may beaffected


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Diffuse increase bone density in the sclerotic

stage on plain x-ray

Areas of relative lucencies may be seen duepersistent fibrosis.

Irregular periosteal reaction particularly near the

end of long bones may occur. Seen on plane x-

ray, CT and mri. Increase uptake at ends of longbones on RN studies

MRI and uss ll demonstrate hepatomegally.

Diffuse increas uptake of bone tracer in affectedbones, possibly superscan


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(C)Mastocytosis

Presents like myelofibrosis but usually

less diffuse and are accompanied by

Urticaria Pigmentosa.

Age < 6 mths in 50%


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(D)Renal osteodystrophy

Constellation of musculoskeletalabnormalities that occur with CRF

Combination of a)Osteomalasia/rickets.

b)Bone changes of HPT. c)Osteosclerosis. d)Soft tissue + vascularcalcifications

Cause by bilateral chronic pyelo or CGN End stage bilateral small contracted

kidneys


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On plain radiograph

Diffuse osteosclerosis is one of theradiological signs esp with CGN

Diffuse chalky density of the

thoracolumbar spine in 60% withRUGGER-JERSEY spine( sclerosis

confined to upper and lower 3rd of each

body); also in pelvis, ribs, long bones,facial bones and base of skull esp in

children.


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Soft tissue and vascular calcifications are

noted on CT, MRI .

Bony changes of rickets/ osteomalasia are

also noted on plain radiograph, CT and

MRI.

Bilateral small contracted kidneys are

seen on USS and MRI.


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(E)Fluorosis

Due to chronic fluoride poisoning.

Almost always endemic

Subjects live were the drinking water has highfluoride content;>10 parts/million. India, Chinaand countries bordering the persian gulf.

Occupational from inhaled or ingested fluorine inAluminium workers

In wine drinkers were fluorine is used as

preservatives. Clinically present with mottled dental enemal or

asymptomatic.


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Increase bone density and thickening of

the cortex at the expense of the medullary

cavity seen on Plain x-ray,CT.

Ossification takes place at ligamentous

and musculo-tendinous attachments giving

the FRINGED appearance. Seen plain x-

ray,CT and MRI


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(F)Melorheostosis(Leris Dx)

Non hereditary disease of unknown

etiology.

Rare . Age > 3yrs.

Could present with pains and restricted

joint movt but often asymptomatic.

Commonly affects the lower limbs. Skull spine and ribs are rarely involved.


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Plain radiograph show overgrown dense

irregular sclerotic bone running down the

cortex giving Candle wax dripping

appearance.

May cross joints with joint fusion.

Ectopic bones may be seen in soft tissues

esp in joints between affected bones.

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Diffuse Osteosclerosis - Onuwaje