Case Of the Week (COW) 05 Oct 2014
Answer:
Renal osteodystrophy with pseudofractures
Findings:
Both kidneys show severe hydronephrosis with tortous ureters -Bilateral grade v reflux.
Cortical thinning - "pencil-thin cortex“ Wide transverse lucencies traversing bone at right angles to left femoral cortex on the medial aspect but do not cross the entire bone.They have sclerotic irregular margins. Retrospective lab investigation showed elevated renal parameters.
Discussion:
Also called Umbau zonum. Focal collections of osteoid may produce ribbon-like transverse zones of incomplete radiolucency, particularly notable on concave side of the long bones, the medial side of the femoral neck, the ischial and pubic rami, the ribs, the clavicles, and axillary border of the scapulae. Milkman pseudofracture or Looser lines usually show increased activity on bone scans and may, under stress, propagate to become true fractures. These lesions are composed of poorly mineralized osteoid matrix and are not true fractures or stress fractures.
DIFFERENTIATING FROM PAGETS INSUFFICIENCY FRACTURE: Similar changes radiographically may be seen in Paget's disease. They are only seen in involved bone and are not generalized. The lines in Pagets occur on the convex side of the bone(tensile aspect) while in osteomalacia it occurs on the concave side (compressive aspect).
Contributed By:
Dr. Balaji Ayyamperumal
Tanjore Medical College
Answer:
Renal osteodystrophy with pseudofractures
Findings:
Both kidneys show severe hydronephrosis with tortous ureters -Bilateral grade v reflux.
Cortical thinning - "pencil-thin cortex“ Wide transverse lucencies traversing bone at right angles to left femoral cortex on the medial aspect but do not cross the entire bone.They have sclerotic irregular margins. Retrospective lab investigation showed elevated renal parameters.
Discussion:
Also called Umbau zonum. Focal collections of osteoid may produce ribbon-like transverse zones of incomplete radiolucency, particularly notable on concave side of the long bones, the medial side of the femoral neck, the ischial and pubic rami, the ribs, the clavicles, and axillary border of the scapulae. Milkman pseudofracture or Looser lines usually show increased activity on bone scans and may, under stress, propagate to become true fractures. These lesions are composed of poorly mineralized osteoid matrix and are not true fractures or stress fractures.
DIFFERENTIATING FROM PAGETS INSUFFICIENCY FRACTURE: Similar changes radiographically may be seen in Paget's disease. They are only seen in involved bone and are not generalized. The lines in Pagets occur on the convex side of the bone(tensile aspect) while in osteomalacia it occurs on the concave side (compressive aspect).
Contributed By:
Dr. Balaji Ayyamperumal
Tanjore Medical College