CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 2 Generalized Osteoporosis

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig B 2-1 Osteoporosis of aging. Generalized
demineralization of the spine in a
postmenopausal woman. The cortex appears
as a thin line that is relatively dense and
prominent (picture-frame pattern).

4. • Fig B 2-2 Steroid therapy. Lateral view of the
thoracic spine in a patient on high-dose steroid
therapy for dermatomyositis demonstrates
severe osteoporosis with thinning of cortical
margins and biconcave deformities of vertebral
bodies.

5. • Fig B 2-3 Scurvy. (A and B) Frontal views of both knees demonstrate
widening and increased density of the zone of provisional
calcification, producing the characteristic white line of scurvy. Note
also the submetaphyseal zone of lucency and the characteristic
marginal spur formation (Pelken's spur). The epiphyseal ossification
centers are surrounded by a dense, sharply demarcated ring of
calcification (Wimberger's sign).

6. • Fig B 2-4 Cushing's syndrome due to adrenal hyperplasia. Marked
demineralization and an almost complete loss of trabeculae in the
lumbar spine. The vertebral end plates are mildly concave, and the
intervertebral disk spaces are slightly widened. Note the
compression of the superior end plate of L4.3

7. • Fig B 2-5 Multiple myeloma. (A) Diffuse skeletal
deossification involving the pelvis and proximal
femurs. (B) Generalized demineralization of the
humerus with thinning of the cortices.

8. • Fig B 2-6 Leukemia. Patchy areas of deossification
throughout the metacarpals and phalanges.

9. • Fig B 2-7 Thalassemia. Lateral view of the ankle demonstrates
pronounced widening of the medullary spaces with thinning of the
cortices. Note the absence of normal modeling due to the pressure
of the expanding marrow space. Localized radiolucencies simulating
multiple osteolytic lesions represent tumorous collections of
hyperplastic marrow.

10. • Fig B 2-8 Juvenile rheumatoid arthritis. Lateral
view of the ankle demonstrates severe
demineralization of bone. Note the pronounced
narrowing of the joints involving the talus and
other tarsal bones.

11. • Fig B 2-9 Osteogenesis imperfecta.
Pronounced osteoporosis and cortical thinning
of all bones with evidence of previous
fractures and resultant deformities.

12. • Fig B 2-10 Muscular dystrophy. Thin, demineralized bones of the
lower leg. The increased lucency, representing fatty infiltration in
muscle bundles, makes the fascial sheaths appear as thin shadows
of increased density (arrows) surrounded by fat.

13. • Fig B 2-11 Niemann-Pick disease. Diffuse widening of the
metacarpals and phalanges with thin cortices and
coarsened trabeculae.4