Musculoskeletal manifestations of endocrine disorders

Endocrine disorders can lead to disturbances in numerous systems within the body, including the musculoskeletal system. Radiological evaluation of these conditions can demonstrate typical appearances of the bones and soft tissues. Knowledge of these patterns can allow the radiologist to suggest a diagnosis that may not be clinically apparent.This review will highlight the typical musculoskeletal findings of acromegaly, hypercortisolism, hyperthyroidism, hypothyroidism, hyperparathyroidism, pseudo- and pseudopseudohypoparathyroidism, and diabetes mellitus. The radiological manifestations of each of these endocrine disorders, along with a brief discussion of the pathophysiology and clinical implications, will be discussed.     

Musculoskeletal manifestations of diabetes mellitus

Rheumatic complaints are common in patients with diabetes. Maintaining good glycaemic control by exercise, diet, and medication improves or prevents the development of rheumatic conditions.     

Musculoskeletal manifestations of neurofibromatosis type 1

OBJECTIVE: We will describe and illustrate various musculoskeletal manifestations of neurofibromatosis type 1 (NF1) encountered on imaging studies. CONCLUSION: Because NF1 is one of the most common genetic disorders, radiologists should be familiar with its imaging manifestations.     

Musculoskeletal infections: US manifestations.

One of the most important prognostic factors in patients with musculoskeletal infections is the delay in establishing therapy. Early diagnosis of septic arthritis requires analysis of joint fluid. Ultrasonography (US) is a rapid, portable, sensitive technique for confirming the presence of joint effusions. The study can be easily repeated for follow-up of lesions. US allows real-time guidance of fluid aspiration and can reduce the risk of contaminating other anatomic compartments, especially in the hands, wrists, and feet. Radiography provides complementary information and should be performed in conjunction with US. US is the imaging modality of choice for diagnosis of superficial abscesses. Dynamic compression with the US probe and color Doppler imaging can facilitate detection of superficial abscesses. US may help in the early diagnosis of osteomyelitis by demonstrating subperiosteal or juxtacortical fluid collections and by providing guidance for aspiration of these collections. Evaluation of osseous involvement requires additional imaging; a US examination with normal results does not allow exclusion of bone infection. US is not degraded by metallic artifact and may be useful in cases of osteomyelitis complicating metallic fixation in an extremity. After initial radiography, US can play an important role in the management of musculoskeletal infections.     

Musculoskeletal manifestations of hemophilia: imaging features

The purpose of this pictorial assay is to demonstrate the imaging features of the various musculoskeletal manifestations of hemophilia, an X-linked disorder. Depending on the site of recurrent bleeding, musculoskeletal manifestation can be in the form of hemophilic arthropathy and/or soft tissue, intraosseous, or subperiosteal pseudotumors. Radiography, sonography, computed tomography, and especially magnetic resonance imaging help in the evaluation of hemophilic arthropathy and pseudotumors, providing accurate diagnosis, thus avoiding inadvertent procedures and related complications. Treatment includes replacement of clotting factors either continuously or when indicated, radionuclide or open synovectomy in cases of disabling arthropathy.     

Musculoskeletal complications of acromegaly: what radiologists should know about early manifestations

The purpose of this article is to summarise the early musculoskeletal complications of acromegaly. Some of the early signs of acromegaly may be evaluated by the musculoskeletal radiologist. In the early stage of disease, peripheral nerve enlargement associated with carpal tunnel syndrome or cubital tunnel syndrome and thickening of retinacula, such as A1 pulley in trigger finger, represent the features that may be seen by radiologists and are worthy of an endocrinological evaluation. Due to the insidious nature of the disease, the diagnosis of acromegaly is significantly delayed. Few and nonspecific symptoms characterise the initial phases of the disease, and therefore, most patients will have generally consulted many specialists (most frequently musculoskeletal radiologists) before an adequate endocrinological assessment is performed. For this reason, initial clinical signs are much more important than symptoms for an early diagnosis of acromegaly. The first and most important therapeutic approach to acromegaly is early diagnosis, whereas the therapeutic goals are to eliminate morbidity and reduce mortality to the expected age- and sex-adjusted rates and prevent the development of systemic complications. Musculoskeletal radiologists should be aware that these features may be early manifestations of acromegaly. When both radiological and clinical abnormalities are present, an endocrinological workup is useful to diagnose the disease in an early phase.     

Musculoskeletal manifestations of sickle cell disease,diagnosis with whole body MRI

Purpose

The aim of work is to define the musculoskeletal abnormalities in patients with sickle-cell disease using whole body MRI.

Patients and methods

Twenty-seven patients with known sickle cell disease were included in this study complaining of acute painful vaso-occlusive crisis. All the patients complaining of bony pain in different body regions. Some patients complaining of bony swellings and joint pain. Whole body (W.B) MRI studies were performed for all the patients .Three coronal (T1, T2, and STIR) sequences were performed for whole-body MR imaging. In selected cases, dedicated examination of certain body parts was performed.

Results

Persistent red marrow, intramedullary bone hyperplasia and bone infarcts were seen in all patients. Vertebral bone infarcts were found in 23 patients. Bilateral proximal femoral head epiphysis avascular necrosis were found in 9 patients. Osteomylitis was diagnosed in 6 patients and septic arthritis in 2 patients.

Conclusion

Whole body MRI can help identifying muscloskeletal abnormalities in sickle cell disease in a single session. MRI is a useful imaging tool in distinguishing acute osteomylitis and bone infarct. Knowledge of the range of imaging findings is crucial in order to accurately depict the complication and initiate appropriate therapy.     

The skeletal manifestations of chronic myelogenous leukemia

Skeletal lesions were radiographically apparent in 6 of 36 (16%) patients with chronic myelogenous leukemia. The spectrum of radiographic changes including diffuse osteoporosis, focal osteolytic and osteoblastic lesions, chloroma, and arthritis, and their clinical behavior is discussed.     

儿童慢性肉芽肿病胸部CT表现

目的分析儿童慢性肉芽肿病(CGD)胸部CT的特征性表现。方法搜集我院2004年6月～2009年12月确诊的30例CGD患儿,对其胸部CT及实验室检查进行回顾性分析和总结。结果 30例CGD患儿,发病年龄小于2岁的有23例,大多数患儿以呼吸道感染来诊,CT发现纵隔、腋下淋巴结肿大27例,淋巴结钙化17例,其中卡介苗接种同侧淋巴结钙化14例,肺内斑片、片状实变19例,结节及团块样病变24例。实变及结节内空洞12例,小叶间隔增厚11例,胸膜增厚10例,少量胸腔积液10例,支气管扩张9例。此组患儿实验室检查33次,病原菌明确的21次检查中5次为曲霉菌感染,并与影像学检查吻合,病原菌未明确的12次检查中,影像学提示为曲霉菌感染的占4次。结论 CGD患儿肺内主要表现包括实变、结节、团块、空洞,间质改变常见。结节与团块样改变高度提示曲霉菌感染,尤其在病原菌检查不明确时,CT对提示曲霉菌感染有很大帮助。纵隔、腋下淋巴结肿大、卡介苗接种同侧腋下淋巴结钙化具有一定特异性,能为临床提供有价值的诊断信息。     

Musculoskeletal melioidosis

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, mostly affecting patients in Southeast Asia and northern Australia. The disease has been increasingly recognized around the world due to the increased levels of travel and population movement. Clinical manifestations of melioidosis range from fulminant septicemic illness to an indolent local infection. The disease often involves multiple organs, including the lung, spleen, liver, and other visceral organs. Musculoskeletal infection is usually seen as a part of multiorgan involvement, but localized musculoskeletal involvement may occur. The most common manifestation of musculoskeletal melioidosis is septic arthritis, followed by osteomyelitis, pyomyositis, and soft tissue abscesses. The clinical and radiological manifestations of musculoskeletal melioidosis are nonspecific, and the diagnosis needs a high level of suspicion. Associated infection of lungs and visceral organs is suggestive of melioidosis. The disease requires special laboratory facilities and treatment. Inappropriate or inadequate treatment leads to high mortality rate or long-term relapse of the disease. The causative organism of melioidosis, clinical manifestations, and imaging features of musculoskeletal melioidosis are reviewed.