Long bones manifestations of congenital syphilis

Transcription

1 Long bones manifestations of congenital syphilis Poster No.: C-0139 Congress: ECR 2011 Type: Educational Exhibit Authors: T. F. de Souza 1, P. P. Collier 1, E. J. M. Bronzatto 1, G. L. P. Keywords: DOI: Martins 2, E. M. D. B. Pacheco 1 ; 1 Campinas/BR, 2 Campinas, Sa/ BR Musculoskeletal bone, Pediatric, Education, Plain radiographic studies, Infection, Parasites /ecr2011/C-0139 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 30

2 Learning objectives To analyze the osseous manifestations of the Congenital Syphilis in long bones. To reinstate the congenital osseous manifestations as an important element in the differential diagnosis of the disease in infancy. To call attention to the radiological changes to the new generation of radiologists who underwent their training at the time when the disease was a rarity. Background Congenital syphilis is a re-emergent medical problem and radiology plays an important role in the early diagnosis 1. The common findings are metaphysitis, periostitis and osteitis of the long bones 2. Transverse metaphyseal lucencies occur early in the disease, and with Wimberger's sign they are the prime evidence of pathology in syphilitic bone 3. Other radiographic changes are probably owing to minimal trauma 3. Reviews of radiographs in 22 patients with skeletal lesions ascribed to congenital lues from our didactic archive were analyzed. Imaging findings OR Procedure details Metaphyseal Abnormalities: 1. Nonspecific trophic lucent bands 2. Alternating bands 3. Focal fragmentation and destruction Wimberger corner sign Pathologic fractures and callus Page 2 of 30

3 Periosteal reaction Diaphysis abnormalities Images for this section: Fig. 1: Lucent bands in proximal and distal extremity of humerus, radius and ulna Page 3 of 30

4 Fig. 2: Lucent bands in proximal and distal extremity of femur, tibia and fibula Page 4 of 30

5 Fig. 3: Examples of lucent bands in distal extremity of radius and ulna Page 5 of 30

6 Fig. 4: Other examples of lucent bands in distal extremity of radius and ulna Page 6 of 30

7 Fig. 5: Alternating dense and lucent bands in distal femur, and proximal tibia and fibula Page 7 of 30

8 Fig. 6: Alternating dense and lucent bands in distal humerus, radius and ulna, and proximal radius Page 8 of 30

9 Fig. 7: Focal fragmentation and Destruction in distal left femur Page 9 of 30

10 Fig. 8: Other example of focal lesion in distal femur Page 10 of 30

11 Fig. 9: Focal lesion in proximal humerus Page 11 of 30

12 Fig. 10: Wimberger Sign: Metaphyseal destruction in the upper medial tibia, usually sparing the most recently formed few millimeters of metaphysis Page 12 of 30

13 Fig. 11: Wimberger Sign Page 13 of 30

14 Fig. 12: Wimberger Sign Page 14 of 30

15 Fig. 13: Pathologic fracture in ulna, with pseudoartrosis and focal destruction in distal humerus Page 15 of 30

16 Fig. 14: Patient with bilateral callus after pathologic fracture in proximal femur Page 16 of 30

17 Fig. 15: Same patient in a closer view Page 17 of 30

18 Fig. 16: Callus in distal femur with diffuse metaphyseal abnormalities Page 18 of 30

19 Fig. 17: Callus, periosteal reaction and metaphyseal abnormalities Page 19 of 30

20 Fig. 18: Periosteal reaction Page 20 of 30

21 Fig. 19: Periosteal reaction Page 21 of 30

22 Fig. 20: Periosteal reaction Page 22 of 30

23 Fig. 21: Periosteal reaction Page 23 of 30

24 Fig. 22: Patient with diaphysis lucent lesions, metaphysis abnormalities and periostitis Page 24 of 30

25 Fig. 23: Another patient with diaphysis lucent lesions, metaphysis abnormalities and periostitis Page 25 of 30

26 Fig. 24: Diffuse osteitis and metaphysitis in long bones in right upper limb Page 26 of 30

27 Fig. 25: Diffuse osteitis and metaphysitis in long bones in same patient left upper limb Page 27 of 30

28 Fig. 26: Diffuse osteitis and metaphysitis in long bones in same patient right lower limb Page 28 of 30

29 Fig. 27: Diffuse osteitis and metaphysitis in long bones in same patient left lower limb Page 29 of 30

30 Conclusion Congenital syphilis should be considered in a newborn infant with these radiographic manifestations, especially when a suggestive history is obtained. Personal Information References 1 - Centers for Disease Control and Prevention. [Congenital Syphilis - United States, ]. MMWR 2010; 59: Sachdev M, Bery K, Chawla S. [Osseous manifestations in congenital syphilis: a study of 55 cases]. Clin Radiol 1982; 33(3): Rosen EU, Solomon A. [Bone lesions in early congenital syphilis]. S Afr Med J 1976; 50(5): Page 30 of 30