osteochondritis dessicans ,caisson disease, caffey’s disease
DESCRIPTION
radiology Osteochondritis dessicans caisson disease caffey’s diseaseTRANSCRIPT
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OSTEOCHONDRITIS ,Caisson disease,OSTEOCHONDRITIS ,Caisson disease,Caffey’s diseaseCaffey’s disease
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OSTEOCHONDRITIS DESSICANSOSTEOCHONDRITIS DESSICANSMisnomer.
Refers to post-traumatic osteochondral/chondral fractures.
Occuring at articular surface.
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After injury---detached portion
* remain in situ.
*Mildly displaced.
* Become loose body.
(most common cause of loose body in young adults is OCD)
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Fragmented part—avascular
Bed of defect ---vital
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SITES INVOLEDSITES INVOLED CONVEX ARTICULAR SUFACES:
Medial femoral condyles. Capitellum of humerus. Trochlear surface of talus.
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RARE SITES OF INVOLVMENT:
Shoulder—humeral head ,glenoid. Scaphoid. Navicular.
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INCIDENCEINCIDENCE
M:F =2:1.
One third cases are bilateral.
Adolescence.
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RADIOGRAPHIC FEATURES.RADIOGRAPHIC FEATURES.PLAIN RADIOGRAPHS
May be normal.
When visible =radiolucent ring surrounding bony fragment.
=in profile-loose body opposite to pit in bone.Loss of sharp cortical line of articular surface.
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CT FINDINGS Usually axial cuts.
For cortical defects & loose bodies. Island of bone demarcated by rare field zone.
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MRI FINDINGS vitality of underlying bone integrity of overlying cartilage.
NUCLEAR MEDICINE Non specific mild to moderate increased uptake of isotope in involved bone.
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MRI CLASSIFICATION OF OCDMRI CLASSIFICATION OF OCD STABLE * articular cartilage is breached.
*marrow edema.
UNSTABLE *pocket of fluid around undetached ,undisplaced
fragment.
*displaced osteochondral fragment.
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X-ray knee frontal view---radiolucent line on lateral aspect of medial condyle extending up to articular surface. Joint space normal.
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Lateral radiograph of the knee reveals a calcified loose body (white arrowhead) in the infrapatellar fat pad and lucency in the articular surface of the patella (black arrowhead).
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Ankle frontal view---radiolucent line on dome of talus ,medial aspect. resulting in detachment of fragment. No displacement.
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Axial CT of the knee demonstrates a completely detached osteochondral fracture (arrowhead) in the lateral aspect of the medial femoral condyle.
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Coronal CT of the ankle demonstrates a nondisplaced osteochondral fragment
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CT ankle axial cuts.OCD of talar dome.
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T1W & STIR---coronal & sagittal.unstable.
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Stable –adjacent edema
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Stable OCD –coronal & sagittal T2W shows lesion of medial condyle and marrow edema .
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Coronal T2W unstable OCD with fluid at base of lesion
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CAISSON DISEASECAISSON DISEASE DYSBARIC OSTEONECROSIS.
exposure to hyperbaric atmosphere.
Undersea diving ,space craft.
Result in decompression sickness.
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MECHANISMMECHANISMNitrogen bubbles liberated from bone marrow –
bone infarct by small blood vessel occlusion
Resultant osteonecrosis..
Shoulder most commonly involved.
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PresentationPresentation Joint pain
Motion aggravates pain.
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RADIOGRAPHIC FINDINGSRADIOGRAPHIC FINDINGS Juxta articular defects transradiant subcortical band. collapse of articular cortex. sequestration of articular cortex. secondary osteoarthritis.
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Neck and shaft lesions dense areas. irregular calcified areas.
COMPLICATION
1. Malignant fibrous histiocytoma.
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CAFFEY’S DISEASECAFFEY’S DISEASE INFANTILE CORTICAL HYPEROSTOSIS.
Unknown etiology
In twins ,siblings & cousins.
Remission & relapses with patchy distribution of lesion.
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SITESSITES Mandible.
Ribs.
Clavicle.
Scapulae.
No spine involvement.
Diapysis involvement.
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PRESENTATIONPRESENTATIONChild upto 1 year.
High grade fever & hyperirritability.
Painful deep soft tissue swelling. occur before bone lesion appear.
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RADIOGRAPHIC FEATURESRADIOGRAPHIC FEATURESMarked periosteal proliferation.
Cortical thickening.
Soft tissue swelling.
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OUTCOMEOUTCOMEBone returns to normal by 12 weeks.
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Osteoblastic periosteal lesion involving shaft of ulna ,also lateral aspect of radius.
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Deformity, periosteal reaction. Soft tissue swelling.
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