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1 ALTERATIONS IN BONE SHAPE1

Generalized alterations in shape1

Achondroplasia1

Osteogenesis imperfecta (fragilitas ossium)2

Chondro-osteodystrophy3

Acromegaly4

Muscular paralysis5

Regional alterations in shape5

Congenital growth defects6

Craniocleidodysostosis6

Arachnodactyly6

Club foot6

Gross failure in the development of the hands or feet6

Congenital wedge-shaped and supernumerary vertebra6

Spina bifida6

Fusion of vertebral bodies8

Regional deformities due to disease6

Deformity of vertebral bodies8

Faulty modelling of the long bones9

Deformity following epiphyseal damage9

Local bony protuberance9

Exostosis9

External chondroma12

Local bone deficiency12

Collapse of a single vertebra13

Spinal osteoporosis with collapse of a single vertebra13

Vertebral osteochondritis13

Xanthomatous deposit14

Traumatic and post-traumatic collapse14

Hydatid cyst14

Neoplastic secondary deposit15

Secondary deposit with disc intrusion15

Benign tumour15

Paget＇s disease15

Developmental defect16

Tuberculous lession with vertebral collapse16

Deformity from softening of the bones17

The pelvis17

The long bones18

2 ALTERATIONS IN THE POSITION OF A BONE19

Congenital elevation of the scapulae19

Depressed sternum19

Genu valgus19

Spondylolisthesis20

Congenital dislocation of the hip22

Displaced patella24

Congenital dislocation of the talus24

Scoliosis24

3 ABNORMALITIES IN THE REGION OF THE EPIPHYSES26

Alteration in the maturity of the epiphyses26

Acceleration of epiphyseal maturity26

Retardation of epiphyseal maturity27

Acceleration or retardation of epiphyseal fusion28

Generalized alteration in the appearance of the epiphyses28

Developmental defects29

Chondro-osteodystrophy29

Gargoylism30

Dyschondroplasia or chondrodystrophy30

Multiple epiphyseal dysplasia (chondrodysplasia)31

Endocrine epiphyseal defects32

Hypothyroidism (cretinism)32

Dietetic epiphyseal disorders32

Rickets32

Scurvy34

Heavy metal deposition in the metahyseal region35

Abnormality of a single epiphyseal region36

Osteochondritis of the femoral head (Perthes＇ disease)36

Slipped upper femoral epiphysis (adolescent coxa vara)37

Osteochondritis of the tibial tuberosity (Osgood-Schlatter＇s disease)38

Osteochondritis of a metatarsal epiphysis39

Osteochondritis of the navicular (Kohler＇s disease)39

Osteochondritis of the primary centre of a vertebral body (Calvé)39

Osteochondritis of the secondary centre of a vertebral body (Scheuermann＇s disease)40

Uncommon sites of epiphyseal fragmentation (osteochondritis，epiphysitis)40

4 INCREASES IN BONE DENSITY42

Generalized increase in bone density42

Developmental osteopetrosis42

Developmental osteopoikilosis44

Secondary deposits44

Myelosclerosis46

Renal osteosclerosis46

Hypervitaminosis48

Fluorosis48

Paget＇s disease48

Increase in density of a single vertebra48

Secondary deposit of carcinoma48

Hodgkin＇s disease48

Paget＇s disease49

Local vascular disorder49

Low-grade chronic osteomyelitis50

Benign tumour or developmental defect50

Primary bone sarcoma50

Isolated increase in bone density in a limb bone，rib or pelvis50

Developmental defect50

Deep bone infarct50

Healing cyst52

Avascular necrosis or osteochondritis52

Dense lunate52

Dense talus or scaphoid52

Dense patella52

Dense femoral head53

dense terminal phalanx53

Secondary deposit53

Sclerosing osteitis and sarcoma53

Condensans ilii54

Isolated increase in density in the skull or facial bones54

Anatomical variations54

Hyperostosis frontalis55

Meningioma56

Inflammatory lesion56

Secondary deposit56

Leontiasis ossea56

Paget＇s disease56

5 NEW BONE AND CALCIFICATION OUTSIDE THE CORTEX (PERIOSTEAL SHADOW OR PERIOSTITIS)57

Post-traumatic periosteal shadow58

Non-traumatic haematoma58

Stress fracture and fatigue fracture59

Inflammatory conditions61

Pyogenic or typhoid bone infections61

Syphilitic bone lesions61

Tuberculous bone lesions61

Fungus infections of bone62

Benign neoplasm62

Osteoid osteoma62

Malignant neoplasm62

Vascular disorders63

Varicose veins and arterial occlusion63

Pulmonary osteoarthropathy63

Idiopathic hypertrophic osteoarthropathy64

Melorheostosis (Leri)64

Diaphyseal dysplasia (Engelmann)64

6 WIDESPREAD AND REGIONAL DECREASES IN BONE DENSITY65

Introduction65

Widespread even decalcification66

Endocrine disorders66

Cushing＇s syndrome66

Cortisone therapy67

Late stage acromegaly68

Hyperthyroidism68

Ovarian agenesia and eunuchoidism68

Old age68

Dietetic deficiencies68

Calcium and phosphorus68

Vitamin D68

Vitamin C69

Protein69

Alimentary tract disorders69

Osteomalacia from deficient fat and vitamin D assimilation69

Looser zone or Milkman fracture in osteomalacia69

Metabolic disorders－renal osteodystrophy70

Haemopoietic diseases71

Leukaemia in children71

Leukaemia in adults73

Histiocytosis (Gaucher＇s disease)73

Myelomatosis73

Coarsened trabecular pattern associated with decalcification73

Hyperparathyroidism73

Hypoparathyroidism75

Sickle-cell (Cooley＇s) anaemia75

Alimentary tract disorders75

Patchy decalcification77

Secondary neoplasm and myelomatosis77

Old age78

Haemopoietic diseases79

Decreased bone density in one region or group of bones79

Spinal decalcification79

Disuse and sepsis decalcification of part of a limb81

7 A TRANSLUCENT AREA IN A BONE83

Introduction83

Well-demarcated translucent area within a bone83

Simple cysts of uncertain aetiology83

Osteitis fibrosa cystica (in hyperparathyroidism)85

Developmental defects86

Fibrous dysplasia87

Non-osteogenic fibroma (fibrous metaphyseal defect)88

Chondromyxoid fibroma89

Chondroblastoma89

Aneurysmal bone cyst89

Tuberose sclerosis (Mesodermal dysplasia)89

Arterio-venous aneurysm90

Haemangioma90

Chondroma or hamartoma90

Neurofibromatosis92

Tumours92

Osteoclastoma92

Solitary plasmacytoma92

Secondary deposit92

Granulomas94

Xanthomatous granuloma94

Non-specific granuloma95

Histiocytosis (Gaucher＇s disease)95

Sarcoid95

Infective conditions96

Tuberculosis96

Pyogenic infection97

Fungoid infection97

Yaws97

Hydatid cysts97

Post-traumatic cyst-like translucency97

Haemophilia with haemorrhagic bone cyst97

Cyst-like translucency in association with arthritis97

Well-demarcated translucent area with cortical thinning and gross bone expansion98

Simple cyst of uncertain origin98

Hyperparathyroidism (osteitis fibrosa cystica)99

Developmental defects100

Monostotic fibrous dysplasia100

Giant-cell tumour variants100

Chondroma100

Neoplasm101

Osteoclastoma101

Solitary plasmacytoma102

Secondary deposit102

Infection102

Well-demarcated erosion of the surface of a bone104

Pressure erosion104

Pressure from occupation104

Pressure from an aneurysm104

Pressure from a neurilemmoma，ganglioneuroma or dilated intercostal arteries105

Intervertebral disc intrusion (schmorl node)105

Developmental defect and implantation dermoid105

Urate deposit105

Surface absorption of the tip of a terminal phalanx105

Pyogenic infection105

Leprosy105

Trauma106

Vascular disorders106

Neuropathic disorders107

Developmental defect107

Articular cortex surface erosion－osteochondritis dissecans108

Poorly-demarcated translucent area within the bone108

Malignant neoplasm－primary bone or secondary deposit109

Fibrous dysplasia110

Haemangioma110

Xanthomatous granuloma110

Tuberculous lesion111

Poorly-demarcated erosion of the surface of a bone111

Malignant neoplasm111

Xanthomatous granuloma112

Tuberculosis113

A translucent area in the vault of the skull113

Anatomical variations113

Depression for a Pacchionian body113

Emissary veins114

Diploic venous pool114

Congenital parietal foramen114

Developmental defects114

Meningocoele114

Fibrous dysplasia114

Haemangioma114

Intradiploic dermoid and epidermoid114

Extracranial dermoid114

Acquired lesions115

Post traumatic cyst-like area115

Post radiation necrosis115

Hyperparathyroidism115

Xanthomatosis granuloma115

Infective conditions115

Direct trauma115

Secondary deposit115

Response to an intracranial lesion116

Meningioma116

Direct invasion from scalp neoplasm116

Rodent ulcer116

Carcinoma116

8 COMBINATION OF SHADOWS117

Periosteal opacity and erosion117

Pyogenic inflammation117

Tuberculous inflammation121

Syphilis121

Fungus infection123

Actinomycosis123

Madura foot124

Blastomycosis124

Coccidioidomycosis124

Cysts and inocent tumours124

Malignant neoplasm124

Malignant bone tumours with much erosion124

Malignant bone tumours with much calcification127

Malignant bone tumours with much periosteal new bone128

Differential diagnosis129

Periosteal shadow and sclerosis130

Low-grade chronic osteomyelitis131

Diaphyseal dysplasia (Engelmann)131

Osteoid osteoma132

Syphilis132

Malignant neoplasm132

Periosteal opacity with erosion and sclerosis132

Chronic osteomyelitis132

Sequestra in osteomyelitis132

Chronic localized bone abscess133

Osteoid oesteoma133

Malignant neoplasm134

9 ALTERATIONS IN THE BONE ARCHITECTURE135

Paget＇s disease135

Paget＇s disease and sarcoma of bone137

10 ALTERATIONS IN JOINT SPACE (ARTHRITIS) AND ASSOCIATED BONE CHANGES139

Introduction139

The diminished joint space139

Associated bone changes139

Difficulties of classification139

Arthritis of known cause140

Pyogenic arthritis (septic arthritis)140

Gonococcal arthritis141

Virus arthritis141

Tuberculous arthritis141

Haemophilia with arthritis (haemorrhage into a joint)145

Arthritis of unknown cause145

Classical rheumatoid arthritis145

Unusual manifestations of rheumatoid arthritis148

Unusual distribution of affected joints148

Unusual age of onset149

Milder type of lesion149

Unusual radiographic appearances150

Arthritis in association with other diseases150

Arthritis with psoriasis151

Arthritis with ulcerative colitis151

Arthritis with non-specific urethritis152

Arthritis with rheumatic fever152

Arthritis with systemic lupus erythematosus152

Ankylosing spondylitis152

Arthritis of partly-known origin154

Degenerative or osteoarthritis154

Intra-articular loose bodies156

Neuropathic arthritis157

Metabolic defect with arthritis157

11 SOME HINTS ON χ-RAY TECHNIQUE159

Plain radiographs159

To acquire good detail159

To acquire good contrast159

Measurement of bone length159

Tomography160

Selection and spacing of layers160

Simultaneous multisection tomography160

Value oftomography161

Injection of simuses163

Avoidance of excessive radiation163

12 BONE IN UNUSUALSITES AND CALCIFICATIONS IN OR NEAR A JOINT164

Bone in muscle and tendons164

Ossification in a tendon164

Myositis ossificans164

Calcifications in structures or near a joint164

Calcification in a joint cartilage164

Calcification in a joint capsule165

Calcification in a joint ligament165

Calcification in the supraspinatus tendon165

Calification near the finger joints166

Calcification in tuberculous synovitis166

Calcification in a bursa over a joint or a synovial cyst166

APPENDIX167

REFERENCES170

INDEX171