JIA
Fig. 5.42a–c |
Periarticular osteopenia, erosions at the margins of joints, synovial hypertrophy, subchondral cysts and sclerosis, joint space narrowing. |
The knee is the most commonly affected large joint. |
Septic arthritis |
Pus or organisms on arthrocentesis. |
Although acute bacterial infections are usually rapidly destructive and thus tend not to alter epiphy-seal growth, infantile osteomyelitis may accelerate development of the affected epiphysis. |
Legg-Calvé-Perthes disease |
The femoral head is enlarged (coxa magna) and the epiphysis is flattened and deformed from AVN. |
Coxa magna develops during the reparative stage. |
Status post hip dislocation |
Coxa magna with normal architecture. |
Accelerated growth of the affected side occurs after successful relocation of a previously small proximal femoral epiphysis. Necrosis of the femoral head is more common than coxa magna. |
Hemophilia |
Soft-tissue swelling, periarticular osteopenia, epiphyseal overgrowth. Later stages progress to joint space narrowing, marginal osteophyte formation. Synovium is decreased in T1- and T2-weighted signal intensity on MRI. |
|
Turner syndrome |
Small medial tibial plateau with hypertrophy of the medial femoral condyle (Kosovicz sign). |
Short stature, shortening of the fourth metacar-pals, radiocarpal angulation, cervical ribs, Scheuer-mann disease, Madelung deformity. |
Hypochondroplasia |
Large proximal femoral epiphyses with broad metaphyses and short femoral neck. |
Mild form of short-limbed dwarfism. Between the spectrum of achondroplasia to normal. Spinal stenosis. |
Hemihypertrophy |
Unilateral hypertrophy. |
Increased incidence of embryonal tumors, Wilms tumor, neuroblastoma, and hepatoblastoma. |
Klippel-Trenaunay syndrome |
Uneven enlargement of the parts of the affected limb, including the epiphysis. |
Triad of unilateral capillary hemangioma, v arices, and localized gigantism with overgrowth of the skeleton and soft tissues. |
Tibia vara (Blount disease)
Fig. 5.43a, b |
Unilateral enlargement of the distal femoral epiphysis (medal or lateral condyle). |
Overgrowth in distal femur may be in response to changes in the proximal tibia. |
Neurofibromatosis and other phakomatoses |
|
|
Macrodystrophia lipomatosa
Fig. 5.44
Fig. 5.45a, b |
Digits > other parts of the extremities. |
|
Metaphyseal chondrodysplasia, Schmid type |
Affects proximal femoral epiphyses in 75% of patients. Irregular metaphyses resemble rickets. |
Short-limbed dwarfism with a large degree of genu valgum from the age of 2 y. |
Dysplasia epiphysealis hemimelica (Trevor disease)
Fig. 5.46a–c, p. 526 |
(see Table 5.68 ) |
|