Hyperparathyroidism

Hyperparathyroidism RadiologyHyperparathyroidism RadiologyDelamination Bone

Fig. 8.29a Bone resorption along the phalanges and the delamination of the cortex point in the direction of a hyperparathyroidism. This is particularly well seen in the mid-phalanx of the fourth finger (arrow). b This spine shows the characteristic "rugger-jersey" pattern—harking back to the times when rugby players and football players wore horizontally striped shirts instead of walking round as living billboards. The vertebrae show sclerotic bands along the upper and lower end plates. c See a typical rugger player doing his thing.

Fig. 8.29a Bone resorption along the phalanges and the delamination of the cortex point in the direction of a hyperparathyroidism. This is particularly well seen in the mid-phalanx of the fourth finger (arrow). b This spine shows the characteristic "rugger-jersey" pattern—harking back to the times when rugby players and football players wore horizontally striped shirts instead of walking round as living billboards. The vertebrae show sclerotic bands along the upper and lower end plates. c See a typical rugger player doing his thing.

Hypertrophic osteoarthropathy: This entity (syn.: PierreMarie-Bamberger disease) manifests itself as a periosteal new bone formation, particularly of the lower extremities (Fig. 8.31). It is frequently associated with a pulmonary disease (fibrosis, tumor). For that reason, a glance at the fingers (drumstick or clubbed fingers) and the chest radiograph is helpful in most cases.

• Diagnosis: Hannah and Giufeng find the bone structure a little diffuse and washed out. Their suspicion is supported by the information they get when talking to the referring colleague. Mr. Blackbottom has been on dialysis for renal insufficiency for years. His renal osteopathy has long been known. After having puffed his cigarette he is a little more pleasant than before, even friendly, and tells the two students a story or two out of his long and exhausting career as a renal patient. "You gals are alright," he mumbles finally, grabs the plastic supermarket bag containing his very own roentgen archive, and shuffles away.

I Congenital Bone Diseases a, b Osteogenesis imperfecta c Osteopetrosis a, b Osteogenesis imperfecta c Osteopetrosis

Osteogenesis Imperfecta Short Stature

Fig. 8.30a, b Observe the severely decreased bone density and the deformation of the bones in osteogenesis imperfecta. Scoliosis and short stature result. c In osteopetrosis the whole bone is increased in density. d Camurati-Engelmann disease is characterized by an obliteration of the cancellous bone and an expansion of the bone. This sectional CT of the skull base at the level of the sella shows the stenosis of both optical canals (arrows). The patient was already blind on one side.

Fig. 8.30a, b Observe the severely decreased bone density and the deformation of the bones in osteogenesis imperfecta. Scoliosis and short stature result. c In osteopetrosis the whole bone is increased in density. d Camurati-Engelmann disease is characterized by an obliteration of the cancellous bone and an expansion of the bone. This sectional CT of the skull base at the level of the sella shows the stenosis of both optical canals (arrows). The patient was already blind on one side.

I Hypertrophic Osteoarthropathy

I The Case of Hikka Meckinen

Camurati Engelmann Disease

Fig. 8.31 A thick stripe of periosteal new bone formation is visible along the cortex of the tibia and also the fibula. This is reason enough for a smart radiologist to start a diagnostic work-up for pulmonary disease, which would prove that the initial finding in the tibia was indeed hypertrophic osteoarthropathy. Severe venous insufficiency and burn injury of a limb can also set off this kind of periosteal reaction.

I The Case of Hikka Meckinen

Periosteal Stripe
Fig. 8.32 This radiograph shows the foot of Mr. Meckinen. Which disease entities do you have to consider?

Fig. 8.31 A thick stripe of periosteal new bone formation is visible along the cortex of the tibia and also the fibula. This is reason enough for a smart radiologist to start a diagnostic work-up for pulmonary disease, which would prove that the initial finding in the tibia was indeed hypertrophic osteoarthropathy. Severe venous insufficiency and burn injury of a limb can also set off this kind of periosteal reaction.

If we are finished with the image analysis and the clinical information of the referring colleagues is not sufficient, we go ahead and do what no one has dared to do before: We talk to the patient!

I Disuse Atrophy

I Disuse Atrophy

Hyperparathyroidism RadiologyHyperparathyroidism Radiology

Fig. 8.33 a This patient was immobilized for quite a while because of a fracture of the femoral shaft. The inactivity led to an atrophy of the immobilized bone. Radiographically, significantly decreased density and severely coarsened trabecular structure of the bone are seen (left). A view of the contralateral leg shows the normal appearance for comparison (right). b Compare the osseous structure of the right and left feet. The bone density on the left is markedly decreased and the spongiosal structure is coarsened. There is no soft tissue swelling. This patient was immobilized for a very long time because of a complicated lower leg fracture.

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