Give an account of the radiological differential diagnoses of a patient who has diffuse osteosclerosis

Outline
Introduction Differential diagnoses Imaging modalities Radiological characteristics

Introduction
Diffuse osteosclerosis is diffuse increase bone density seen as An overall whiteness (sclerosis) to all or most of the bones. Diffuse loss of visualization of normal trabecular network. Loss of corticomedullary junction.

Possible causes 5MS To PRoOF

1.Metastasis 2. Myelofibrosis 3. Mastocytosis 4. Melorheostosis 5. Metabolic(hypervit D, fluorosis, phosphorous poison) 6. Sickle cell amaemia 7. Tuberous sclerosis 8. Pyknodysostosis 9. Renal osteodystrophy 10.Osteopetrosis 11.Fluorosis

hypothyroidism,

Imaging modalities
Plane Radiographs CT MRI Radionuclide studies Angiography USS

(A)Metastasis
Malignant bone lesion with primary focus outside the bone. Major cause of bone malignancy Mainly from prostate stomach and carcinoid tumours. c/f occult, vague pains, swellings, path #

Plain radiograph
Shows diffuse osteoblastic lesion that produces dense and often well circumscribed area of increased radiopacity affecting majorly the spine, pelvis and ribs then end of humerus and femor, and less often the skull. Multiplicity of lesions Fractures may be seen though not common

 CT shows similar areas of increased bone density and distribution but with a more detailed degree of affectation. Very early bony lesion are detectable, Very small calcifications and soft tissue affectations are delineated. MRI ll show similar lesions as with CT but better soft tissue resolution. Can reveal primary focus.

(B)Myelofibrosis(myeloid metaplasia)
Has intimate relationship with myelosclerosis, polycythaemia rubra vera and CML. Typical pt is a middle age or elderly adult. Presents with fatique, hepatosplenomegally and anaemia. Mainly affecting the red marrow areas esp the pelvis. The whole skeleton may be affected

 Diffuse increase bone density in the sclerotic stage on plain x-ray Areas of relative lucencies may be seen due persistent fibrosis. Irregular periosteal reaction particularly near the end of long bones may occur. Seen on plane xray, CT and mri. Increase uptake at ends of long bones on RN studies MRI and uss ll demonstrate hepatomegally. Diffuse increas uptake of bone tracer in affected bones, possibly superscan

(C)Mastocytosis
Presents like myelofibrosis but usually less diffuse and are accompanied by Urticaria Pigmentosa. Age < 6 mths in 50%

(D)Renal osteodystrophy
Constellation of musculoskeletal abnormalities that occur with CRF Combination of a)Osteomalasia/rickets. b)Bone changes of HPT. c) Osteosclerosis. d)Soft tissue + vascular calcifications Cause by bilateral chronic pyelo or CGN End stage bilateral small contracted kidneys

 On plain radiograph Diffuse osteosclerosis is one of the radiological signs esp with CGN Diffuse chalky density of the thoracolumbar spine in 60% with RUGGER-JERSEY spine( sclerosis confined to upper and lower 3rd of each body); also in pelvis, ribs, long bones, facial bones and base of skull esp in children.

 Soft tissue and vascular calcifications are noted on CT, MRI . Bony changes of rickets/ osteomalasia are also noted on plain radiograph, CT and MRI. Bilateral small contracted kidneys are seen on USS and MRI.

(E)Fluorosis
Due to chronic fluoride poisoning. Almost always endemic Subjects live were the drinking water has high fluoride content;>10 parts/million. India, China and countries bordering the persian gulf. Occupational from inhaled or ingested fluorine in Aluminium workers In wine drinkers were fluorine is used as preservatives. Clinically present with mottled dental enemal or asymptomatic.

 Increase bone density and thickening of the cortex at the expense of the medullary cavity seen on Plain x-ray,CT. Ossification takes place at ligamentous and musculo-tendinous attachments giving the FRINGED appearance. Seen plain xray,CT and MRI

(F)Melorheostosis(Leris Dx)
Non hereditary disease of unknown etiology. Rare . Age > 3yrs. Could present with pains and restricted joint movt but often asymptomatic. Commonly affects the lower limbs. Skull spine and ribs are rarely involved.

 Plain radiograph show overgrown dense irregular sclerotic bone running down the cortex giving Candle wax dripping appearance. May cross joints with joint fusion. Ectopic bones may be seen in soft tissues esp in joints between affected bones.