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Case 5

                                                                                            Contributors

                                          Dr.Ambika Gayad, Dr.Basavaraj Biradar

                                                                       Dr. Radha

Diagnosis

Scurvy

Radiological Findings, Disease course, and Management

 

                        Radiograph Of the Left Knee 

                            

                   AP                                      Lateral 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 Findings

  • Bones reveal generalized decrease in density

  • Soft tissue density is noted in the lower third of shaft of femur causing elevation of fat planes

  • Metaphyseal irregularities with bony spurs oriented perpendicular to the long access of the shaft of femur and tibia (pelkan spurs) noted

  • Evidence of increased density in the peripheral margins of epiphysis - ring epiphysis.

                                                                Chest Radiograph

                                          AP 

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 â€‹Findings

  • Prominent costochondral junctions noted at the anterior ends of 1st, 2nd, and 3rd ribs on the right side

  • Generalized osteopenia noted

  • No other abnormality was seen

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               High Resolution Ultrasound examination of Left Knee                                                           

                                      

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                       

                                   

 

                                       

                                      

 

 

 

 

 Findings

  • Subperiosteal iso to hypoechoic  collection sugestive of subperiosteal hematoma.

  • Metaphyseal irregularities with bony spurs.

  • No joint effusion

           

Diagnosis

 Scurvy

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Course

  • Patient was put on Tab Limcee ½ OD and Aloz drops 0.5ML 

  • No follow up was available after the first visit

 

Discussion

  • Scurvy is a disease caused by deficiency of Vitamin C

  • As a result there is failure in synthesis of collagen and formation of osteoid

  • This leads to osteoporosis and spontaneous bleeding

  • Onset 6mths to 2years. Rarely occurs in adults

 

Radiological Findings

Plain Radiographic findings

  • Generalized loss of bone density or osteopenia 

  • Expansion of the costochondral junctions of the first 6 to 8 ribs

  • Findings marked in long bone metaphyses           

    Fractured or deformed

    Metaphyseal lucency (Trummerfield zone)

    Metaphyseal corner fractures (Pelkan spurs)

    Cupping of metaphysis

  • Normal calcification in growing cartilage causing dense transverse bands Juxta epiphyseal (Frankels white line)

        Around ossific centres of epiphysis (Wimberger's ring sign)

  • Subperiosteal hematoma appearing as soft tissue swelling or peri-osseous calcification

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Ultrasound findings

  • Bony irregularity

  • Bulky subcutaneous plane

  • Subperiosteal hemorrhage

  • Intramedullary or Periosteal mass

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MRI Findings

  • Areas of hemorrhage within bones at the site of fracture and in the periosteum

  • Diffuse marrow changes

  • Multifocal symmetrical signal abnormalities of affected metaphyses

  • Associated marrow enhancement


Differential Diagnosis

  • Rickets

  • Congenital syphilis

 

References

 

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