Outside radiographs of the left forearm demonstrated a well-defined, diffusely sclerotic lesion of the distal ulna with a smoothly marginated, radiodense extra-osseous component and notable absence of irregular or interrupted periosteal reaction
The x-ray showed no evidence of periosteal reaction
or soft tissue swelling (Fig.
Plain radiographic changes of osteomyelitis (cortical erosion, periosteal reaction
, mixed lucency, and sclerosis) may lag clinical disease by up to a month, and diagnosis may require the use of serial radiographs or magnetic resonance imaging (MRI).
The included bony window eloquently depicted the aggressive permeated infiltration and associated periosteal reaction
CT and MRI show local oedema with associated cortical destruction and periosteal reaction
5) Typical radiographic findings of an aggressive bone-forming tumour with a periosteal reaction
and extraskeletal soft tissue extension are present in 80-90% of cases (Table 2) (Fig.
The former, besides being able to display the cross-sectional anatomy of the affected region, also allows fine definition of cortical penetration and periosteal reaction
, as well as permitting a more precise assessment of the lesional matrix and associated bone destruction.
1) It predominantly affects adolescent males and insidiously progresses to disclose typical presentations such as pachydermia, the thickening and coarsening of facial features, the clubbing of digits, hyperhidrosis, edema in the lower legs, arthritis both with and without joint effusion, and periosteal reaction
of the long bones.
Minor features * Localized periosteal reaction
of the lateral cortex (c) * Generalized increase in cortical thickness of the diaphysis * Prodromal symptoms such as dull or aching pain in the groin or thigh * Bilateral fractures and symptoms * Delayed healing * Comorbid conditions (eg, vitamin D deficiency, RA, hypophosphatasia) * Use of pharmaceutical agents (eg, bisphosphonates; glucocorticoids, proton pump inhibitors) (a): Specifically excluded are fractures of the femoral neck, intertrochanteric fractures with spiral subtrochanteric extension, pathologic fractures associated with primary or metastatic bone tumors, and periprosthetic fractures.
A computed tomography scan showed multiple small abscesses adjacent to the nonunited fracture, an irregular periosteal reaction
around the fracture site, and lucency surrounding the medullary rod, suggestive of osteomyelitis (online Appendix Figure, wwwnc.
Magnetic resonance imaging (MRI) provides highly sensitive and specific evaluation for bone marrow edema and periosteal reaction
as well as for the detection of subtle fracture lines.
There is often a periosteal reaction
, and osteosarcomas and chondrosarcomas typically show areas of ossification.