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[Periosteal reaction]
1Department of Radiology, Jikei University School of Medicine.
Insights
Periosteal reactions, or bone shell formations, can be physiological or pathological. Radiological analysis helps differentiate benign from aggressive bone lesions and identify systemic disorders.
Area of Science:
- Orthopedics
- Radiology
- Pediatrics
Background:
- The periosteum is a membrane covering cortical bone, crucial for bone formation, especially in infants.
- Periostitis, inflammation of the periosteum, presents differently in infants and adults.
- Infantile conditions include prostaglandin osteopathy and infantile cortical hyperostosis.
Purpose of the Study:
- To differentiate physiological periosteal reactions from pathological bone lesions.
- To analyze the radiological features of periosteal reactions in single and multiple bones.
- To understand the association of periosteal reactions with systemic disorders.
Main Methods:
- Review of radiological findings of periosteal reactions.
- Analysis of clinical presentations associated with periosteal reactions.
- Correlation of radiological patterns with underlying pathologies.
Main Results:
- Asymptomatic periosteal reactions are often physiological or bone irregularities.
- Symptomatic reactions in a single bone suggest pathology like tumors, infections, or trauma.
- Multiple bone reactions typically present smooth or undulating patterns, indicating systemic diseases.
Conclusions:
- Radiological assessment is vital for evaluating periosteal reaction activity and aggressiveness.
- Periosteal reactions in multiple bones often signify underlying systemic disorders.
- Distinguishing benign from malignant periosteal reactions requires careful radiological interpretation.
Abstract:
The periosteal membrane covers the cortical bone except for the articular surface. The deep layer of the periosteum contains bone-forming mesenchymal cells, capillaries, and nerves. This layer is more active in infants than in adults. Prostaglandin osteopathy, infantile cortical hyperostosis, hypervitaminosis A, and congenital syphilis are examples of periostitis in infants. Incidental asymptomatic periosteal reactions are usually either physiological changes or cortical bone irregularities simulating periostitis. On the other hand, symptomatic periosteal reactions of single bone, such as bone tumor, tumor-like lesion, infection, and trauma, are always pathologic. Careful radiological analysis of periosteal reactions is needed to evaluate the activity and aggressiveness of the lesions. Periosteal reactions of multiple bones usually show solid smooth or undulating patterns. They include pachydermoperiostosis, secondary hypertrophic osteoarthropathy, vascular insufficiency, renal osteodystrophy, and thyroid acropachy. These are usually skeletal manifestations of systemic disorders.