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Periosteal Lesions
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Very Comprehensive presentation on how to approach periosteal lesions in bone.
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Periosteal LesionsDr KE Polden
Livingstone Hospital
2
,Periosteum
• Thin layer surrounding all bone
• Not joints of Long Bones
• Consist of two layers
Fibrous layer (Fibroblasts)
Cambium Layer (Progenitor cells Osteoblasts)
• Nociceptive nerve endings. (Very sensitive to manipulation)
,Periosteal Reaction
• Definition
Non-specific reaction – Due to Irritation of Periosteum.
Malignant tumour
Benign tumour
Infection
Trauma
• Two Patterns of reaction
Benign (Benign tumours and trauma)
Aggressive (Malignant tumours, benign lesions with aggressive behaviour – Infx)
,Benign Periosteal Reactions
• Malignant lesions NEVER cause a benign periosteal reaction!!!
• Thick, wavy & uniform callus formation (Chronic Irritation)
• Periosteum has time to lay down thick new bone – Normal appearance
,Aggressive Periosteal Reactions
• Periosteum has no time to consolidate (Rapid turnover)
• Multilayered, lamellated or bone formation perpendicular to the cortical bone.
• Spiculated and Interrupted
• Codman’s Triangle
, Osteosarcoma Ewing sarcoma Infection
Interrupted periosteal reaction Lamellated reaction Multilayered Periosteal Reaction
Codman’s Focally Interrupted
Triangle Reaction
,
, Differential Diagnosis
• Battered baby Syndrome
• Stress Fractures
• Scurvy
• Tuberculosis
• Congenital/juvenile Syphilis
• Fungal Osteomyelitis
• Typhoid Osteomyelitis
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