Diagnositc Imaging of Bone Marrow Disease
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Transcript of Diagnositc Imaging of Bone Marrow Disease
Musculoskeletal
Bone Marrow Disease
Mohamed Zaitoun
Assistant Lecturer-Diagnostic Radiology Department , Zagazig University Hospitals
EgyptFINR (Fellowship of Interventional
Neuroradiology)[email protected]
Knowing as much as possible about your enemy precedes successful battle
and learning about the disease process precedes successful management
Bone Marrow Diseasea) Malignant Infiltrationb) Secondary Marrow Hyperplasia c) Lysosomal Storage Diseases
a) Malignant Infiltration : See (Bone Tumors)
1-Myeloma2-Leukemia / Lymphoma3-Metastases (small cell tumors)4-Myelofibrosis
b) Secondary Marrow Hyperplasia :1-Hemoglobinopathies (Sickle Cell Anemia)2-Hemolytic Anemias (Thalassemia)
1-Hemoglobinopathies (Sickle Cell Anemia) :
a) Incidenceb) Radiographic Features
a) Incidence :-Hereditary condition caused by the formation of
abnormal hemoglobin (Hemoglobin S) which manifests as multisystem ischemia and infarction as well as hemolytic anaemia
-The highest incidence occurs in individuals of African descent followed by eastern Mediterranean and Middle Eastern populations
b) Radiographic Features :1-Skeletal Manifestations :a) Bone marrow hyperplasiab) Vascular occlusionc) Osteomyelitis2-Other Manifestations
1-Skeletal Manifestations :a) Bone marrow hyperplasia :1-Hair on end appearance of skull (the diploic
space is markedly widened due to marrow hyperplasia, trabeculae are oriented perpendicular to the inner table)
2-Pathologic fractures3-Biconcave H-shaped vertebra (central endplate
depression)4-Osteopenia
b) Vascular occlusion :1-AVN2-Bone sclerosis from infarctions3-Dactylitis (hand-foot syndrome) : bone
infarcts of hands and feet4-Involvement of growing epiphyses leads to
growth disturbances5-H shaped vertebrae
AVN of the hip
Flattening of the femoral heads with a mixture of sclerosis and lucency characteristic of osteonecrosis
Bone infarct , patchy sclerosis of the humeral head and shaft representing multiple prior bone infarcts
Patchy sclerosis of the proximal tibia due to old infarctions
Bone infarct
Hand-foot syndrome , soft tissue swelling with periosteal new bone formation and a moth-eaten lytic process at the proximal aspect of the fourth phalanx
Advanced dactylitis , lytic processes are present at the first and fifth metacarpals along with periostitis which is most prominent in the third metacarpal
c) Osteomyelitis :-High incidence : most caused by
Staphylococcus-Salmonella infection more common than in
general population-Most commonly at diaphysis of long bones-Osteomyelitis and infarction may be difficult
to distinguish
2-Other Manifestations :-Small calcified fibrotic spleen due to autoinfarction-Cholelithiasis-Progressive renal failure-Papillary necrosis-Cardiomegaly : high output congestive heart
failure (CHF)-Pulmonary infarcts
2-Thalassemia : (Cooley’s Anemia)a) Incidenceb) Radiographic Featuresc) Differential Diagnosis
a) Incidence :-Autosomal recessive microcytic anemia that
originated in the Mediterranean region-Quantitative problem of globin synthesis
b) Radiographic Features :1-Skeletal Manifestations :a) Bone marrow hyperplasiab) Vascular occlusion2-Other Manifestations
1-Skeletal Manifestations :a) Bone marrow hyperplasia :-Marrow proliferation consists of expansion of the medulla,
thinning of cortical bone and resorption of cancellous bone resulting in a generalized loss of bone density
-Expands the marrow space : hair-on-end skull, boxlike digits
-Osteopenia-Premature closure of growth plates-Paravertebral masses due to extramedullary
hematopoiesis-Ribs : rib within a rib appearance noted particularly in the
middle and anterior portions of the ribs
A generalized loss of bone density is observed , the cortex is thinned and the trabeculae are coarsened and outline localized lucency , widening of the medullary cavity has resulted in squaring of the metacarpals
Marrow expansion and cortical thinning
Left : There are large paraspinal masses (white arrows) with smoothly marginated lobulated contours , all of the ribs (red arrow) are expanded and the overall bone density is increased , Right : large paraspinal masses are seen (white arrows)
Extramedullary hematopoiesis , lobulated soft tissue opacities are noted overlying the ribs anteriorly and posteriorly
Extramedullary hematopoiesis
Rib within rib sign
b) Vascular occlusion :-Scattered bone sclerosis-H-shaped vertebral bodies-AVN less common than in sickle cell
disease
2-Other Manifestations :-Cardiomegaly and CHF-Secondary hemochromatosis-Cholelithiasis
c) Differential Diagnosis : OsteosclerosisRegular Sex Makes Occasional Perversions Much More
Pleasurable And Fantastic :1-Renal osteodystrophy2-Sickle cell anemia / Thalassemia3-Myelofibrosis4-Osteopetrosis5-Pyknodystosis6-Metastases7-Mastocytosis8-Paget’s disease9-Athletes10-Fluorosis
c) Lysosomal Storage Diseases :1-Gaucher's Disease2-Niemann-Pick Disease
1-Gaucher's Disease :a) incidenceb) Radiographic Featuresc) Differential Diagnosis
a) Incidence :-Is the most common lysosomal storage disease-The most common genetic disease among
Ashkenazi Jews - It is a genetic multisystem disease arising from a
deficiency of glucocerebrosidase activity resulting in accumulation of a glycolipid (glucocerebroside) within the lysosomes of macrophages particularity in the bone marrow , spleen and liver
b) Radiographic Features :1-Skeletal manifestations2-Other manifestations
1-Skeletal manifestations :-Osteopenia-Osteonecrosis-Pathological / crush fractures-Endosteal scalloping (erosion of the inner cortex)-Erlenmeyer flask deformities (typically on a
femoral radiograph where there is relative constriction of the diaphysis and flaring of the metaphysis)
-H shaped vertebra
Erlenmeyer flask deformity
2-Other manifestations :-Spleen :-Massive splenomegaly-Splenic nodules-Splenic infarcts-Liver :-Hepatomegaly
c) Differential Diagnosis :-Erlenmeyer flask deformity, can be seen in :L CHONG1-Lead poisoning2-Craniometaphyseal dysplasia3-Hemoglobinopathies : thalassemia , sickle cell
anemia4-Osteopetrosis5-Niemann pick syndrome6-Gaucher’s disease
2-Niemann-Pick Disease :-Deficiency of sphingomyelinase-Radiographically similar to Gaucher's
disease except that AVN and cystic bone lesions do not occur