Long Bone, Metaphyseal Cupping



Long Bone, Metaphyseal Cupping


Cheryl A. Petersilge, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Normal Variant


  • Child Abuse, Metaphyseal Fx (Mimic)


Less Common



  • Renal Osteodystrophy


  • Rickets


  • Pediatric Fracture


  • Prolonged Immobilization


  • Sickle Cell Anemia


Rare but Important



  • Post Infection


  • Radiation Induced


  • Scurvy


  • Hypophosphatasia


  • Achondroplasia


  • Metaphyseal Dysplasias


  • Polio (Prolonged Immobilization)


  • Hypervitaminosis A


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Rickets, renal osteodystrophy, and hypophosphatasia: Overgrowth of disorganized chondrocytes



    • Hint: Involves sites of rapid growth: Distal radius/ulna, distal femur, proximal tibia, costochondral articulations


  • Other entities: Oligemia, thrombosis create central metaphyseal depression; causative insult need not be at growth plate



    • May be isolated or involve random sites


Helpful Clues for Common Diagnoses



  • Child Abuse, Metaphyseal Fx (Mimic)



    • Horizontal shear through growth plate; periostitis during healing


Helpful Clues for Less Common Diagnoses



  • Renal Osteodystrophy



    • Combination of rickets & hyperparathyroidism


  • Pediatric Fracture



    • Delayed complication


  • Prolonged Immobilization



    • Associated disuse osteoporosis


  • Sickle Cell Anemia



    • Metacarpals, metatarsals; AVN, infarcts, coarse trabecula, dactylitis, osteomyelitis


Helpful Clues for Rare Diagnoses

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Aug 10, 2016 | Posted by in PEDIATRICS | Comments Off on Long Bone, Metaphyseal Cupping

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