Common bone diseases in diagnostic imaging

2021-07-03 04:29 PM

Osteoarthritis, which begins as a condition of disordered, insufficiency of bone circulation due to inflammation of the bone vein thrombosis.


It is a common bone disease that occurs every day. With clear clinical symptoms, with typical routine radiographs, there is no difficulty in early diagnosis and effective treatment for patients. However, there are also difficult, atypical cases that sometimes require expensive diagnostic methods such as computed tomography, magnetic resonance imaging, and modern tests.

Characteristics of bone lesions on routine radiographs

Osteoporosis and subsequent bone resorption.

Focal necrosis of bone tissue forms foci of abscesses and dead bone fragments.

The disease usually occurs at a young age, the highest rate is at the age of 15, more men than women.

Location of injury

The first common focal point is the ends of the long bones, as a rule, near the knee, distal to the elbow joint.

Pathophysiology and pathogenesis

Osteoarthritis begins as a state of disorder, insufficiency of bone circulation due to osteo-thrombophlebitis, edema develops in bone tissue and function of osteoclasts, osteoblasts. reversed.

The blood supply is interrupted due to septic thrombosis in the bone (thrombose septique), and at the same time, the inflammatory organization develops, creating uneven lesions with many different stages.


All pathogens can cause osteomyelitis, but staphylococcus aureus is the main cause.

X-ray images and progression

Signs of bone damage appear at least 3 weeks after infection. Uneven and diffuse osteoporosis at the ends of long bones or gnawing images at the proximal synovial margin. There is a reaction in the periosteum adjacent to the first focal point causing the border of the periosteum to be irregular.

Progressive damage leads to bone necrosis that creates an abscess. Sometimes there are many necrotic foci connected inside containing a piece of bone called a dead bone fragment (coffin shape, duration of weeks or months).

Following the destruction, there is a defensive bone-thickening reaction that persists for many months. The border of the bone body is irregular and deformed "rotten wood" mixed with dead bone fragments with a higher density than the surrounding necrotic tissue.

Radiographic images in the acute phase: bone destruction is predominant, the bone margins are irregular, and the periosteal reaction is intense. This stage is often accompanied by pathological fractures.

When the disease progresses to the chronic stage: strong bone solidification, abscesses, decayed bone fragments, wider periosteal reaction.

The above pathological picture is clearly improved with antibiotic treatment. The chronic form does not leave any sequelae, but the acute form can have sequelae in children or healthy adults. With early treatment, the infection rarely penetrates the bone, when there is bone damage, the image of osteoporosis and bone resorption is quickly replaced by osteopenia (the formation of new bone tissue). In case of not responding to medical treatment, it is necessary to be wary of pseudo inflammatory osteosarcoma or combine it with surgical treatment.

Atypical forms of osteomyelitis

Nine sides: osteomyelitis of the fingers.

Abcès Brodie: or an abscess in the center of the bone, is a form of osteomyelitis localized to the ends of the bones, at the base of the extremities or in the body of the tibia. It can be confused with osteosarcoma.

Poncet's osteomyelitis: rare.

Garré's fibrous osteomyelitis.


Flat and short osteomyelitis.

Pseudotumor osteomyelitis.

Syphilis osteomyelitis: very rare nowadays, mainly we see osteomyelitis in the third stage, the bone is usually the tibia. The bony body is enlarged, dense, and curved forward, called the "scabbard shape".

Ultrasound images for osteomyelitis have no specific value, but thanks to high-resolution machines, with high-frequency probes (from 7 to 10MHZ), we can coordinate the assessment of membrane lesions. bone, soft tissue around inflammation, organization of joints, ligaments, synovial fluid.

Tuberculosis of bones and joints

Features on routine radiographs

Bone loss is key.

Very little solid bone, rare abscesses, and dead bone fragments.

There is often associated joint damage.

Location of injury

Localized disease is mostly in the ends of bones near the cartilage of large joints, taking on heavy mechanical functions: hip, knee, ankle, shoulder, wrist, elbow, spine (osteitis - spinal joint) - spondylodiscitis). The incidence of TB did not favor any age group, and there was no gender difference.

Tuberculosis arthritis is almost exclusively in one joint. The disease is usually detected when the signs of moderate and chronic arthritis are present: pain, limited range of motion, sometimes swelling, local hyperthermia. Naturally, the erythrocyte sedimentation rate is increased, and tuberculosis is often present.

X-ray images and progression

Osteoarthritis - TB joints have signs that are initially subtle, such as: blurred edges of the joint surface, there is osteoporosis under the articular cartilage. Then the symptoms become more obvious:

Joint slot narrowing.

Irregular joints.

Perichondral defects, often present very early.

Destruction of subchondral bone, the border is not clear, there is a marked reduction in the density of both joints in the lumen of the bone head.

If treatment is initiated before significant cartilage destruction occurs, the disease will be cured without sequelae. Spontaneous progression can lead to insidious joint destruction and then ankylosing spondylitis.

In some cases, radiographic findings are subtle, and comparison of radiographs, especially computed tomography, can help detect bone destructions that are difficult to see on plain radiographs. Finally, some may begin in the synovial cyst, where there are practically no radiographic findings, visible only on magnetic resonance imaging or on ultrasound imaging.

A definitive diagnosis is necessary to initiate anti-tuberculosis treatment, which can be achieved by culturing the aliquot, by doing an RNA strand test, or even by synovial biopsy in the most difficult cases.

Clinical forms

Tuberculosis of the hip:

The first radiographic signs are calcium loss and joint space narrowing. Blurred margins localized near the attachment of the round ligament, the superior part of the base of the acetabulum, and the anterior or posterior portion of the femoral neck. Later, the lesions become more obvious. The abscesses are visible in the software.

Tuberculosis of the knee joint (cold tumor of the knee):

First, the intraarticular effusion is very conspicuous as a pear-shaped blur on the underside of the quadriceps tendon. Loss of calcification with a periarticular defect is localized in the circumference of the tibial margin, in the lateral part of the condyle, and in the intercondylar groove.

Tuberculosis of the wrist joint (cold tumor of the wrist):

Initially, the disease presents with premature calcification of the entire carpal mass, and often with joint cleft stenosis. Later there may be mild dislocations (subluxation).

Shoulder tuberculosis:

Initially, in addition to the loss of calcium, the most characteristic sign was the ax-shaped perichondral defect of the upper humerus. Later, bone destruction becomes more obvious.

Tuberculosis of the sacroiliac joint:

Usually occurs in young people, on both sides and mostly men, so it is easy to mistake it for ankylosing spondylitis. But arthritis is only on one side. Joint space enlargement is often associated with early marginal thickening. Abscesses may appear distant.

Tuberculosis in children:

The TB process entails a change in the vascular network of the bone head with the early appearance and premature development of ossification nuclei. Spontaneous ossification is common.

Figure: Tuberculosis of the joint cartilage.
(a. TB of the hip joint; b. TB of the knee joint; c. TB of the shoulder joint)

Tuberculosis of the spine - joints of the spine (Pott's disease)

Typical form in young people:

Localized to the back, the disease was discovered due to pain and stiffness of the spine. The presence of a TB disease is very valuable and makes it valuable to look for pain on palpation or percussion of a vertebral spine, sometimes just a neurologic finding.

Radiographs are important, must have accurate straight and slanted films of the intervertebral spaces, not misaligned, and possibly straight and slanted tomographic films.

There are 3 main types of X-ray images:

The intervertebral space is narrowed.

The corresponding vertebral faces are corroded, gnawed, calcified, sometimes with symmetrical defects.

The soft tissues around the vertebrae, where the rhomboid opacities can be seen, represent a cold abscess due to tuberculosis.

Later, the intervertebral disc stenosis increased, the destroyed vertebrae interlocked, leading to humpback, we had more symptoms of "spokes-shaped ribs". Anterior bone spurs appear later.

Later, the remaining vertebrae will stick together, forming a vertebral mass.

Under the effect of treatment, people see solid bone around the bone resorption, then the repair process takes place gradually, but the existing lesions still exist and become sequelae.

Atypical forms:

Depending on the lesion: the cervical spine is often detected quickly but can have severe neurological manifestations. In contrast, lumbar spine lesions may be clinically inconspicuous, long-term, or often present with low back pain of little significance.

Depending on the location: in patients with organ transplantation, lesions are often multi-vertebrae, many vertebrae are injured but the discs are not deformed for a long time (here the benefits of tomography to see defects). In children, humpbacks appear early because many successive vertebrae interlock.


Or the abscess is detected by the software. Easy detection on ultrasound or on magnetic resonance.

Complications of tuberculosis: lung, pleura, kidney, bone - joint.

Complications depend on localization, especially neurological complications (paralysis of the lower extremities due to compression).

Figure: Tuberculosis of the thoracic spine.
(1. joint space narrowing; 2. erosive joint surface; 3. osteolytic defect; 4. cold rhomboid abscess)

Benign bone tumor

General features

Slow growth.

Clear limits.

No metastasis.

Usually develops during bone growth.


Depending on the origin of the disease, people classify benign bone tumors as follows:

Osteometrioma: Common in the skull and facial bones. In the location of dense bone tissue with dense, irregular bone density.

Osteoma osteoid: Common in the long bones of the lower extremities, small in size.

Osteoblastoma: Rare, usually found in the spine, large, long bones of the extremities. The tumor may be non-enhanced or contrast-enhanced, with speckled contrast.

Osteochondroma: is an inherited bone disease. The tumor is usually located next to the cartilage, near the knee or elbow joint. This type can be malignant.

Chondroma: Usually solitary in the fingers and toes. Or cause pathological fractures. Is a non-opaque or mottled structure.

Benign chondroblastoma: Common in adolescents, large mid-capsular, non-contrast shape, thin shell, protruding from the periosteum.

Benign tumor with giant cells (Tumeur à Myeloplaxe, Tumeur à cellule géante): That is, tumors of osteoclasts. Found only in adults, at the ends of the bones, there is a honeycomb or soapy light. Tumors can degenerate and become malignant.

There are also tumors:

Vascular, cyst, mixed fibrocartilage, and aneurysm are also classified as benign bone tumors when they are in the bone.


Figure: Common sites of bone tumors.

Primary malignant bone tumor

General features

Rapid growth.

Limit unknown.

Invasion of the periosteum and surrounding soft tissue.

Rapid metastasis.

Often called osteosarcoma, 80% of cases are in the metaphysis of the knee.


Depending on the origin of the tissue, we have the following types:

Sarcoma osteogenic.



Ewing's sarcoma (periosteum).



Adamantinoma also known as Angio blastoma, Dental Ameloblastoma: Is a mass of pseudo epithelial cells, fibrous matrix, squamous cells, vacuoles, vascular transformation. Usually invades surrounding epithelium, if in mandibular 1/3 due to dental cyst. Recurrent and more invasive after resection.

Common in tibia, fibula, ulna, arm, wrist, ankle, femur.

There is a circular defect with eccentric tendency, fibrous margin, multi-focal, with lime plate inside.

On X-ray images there are only 2 types that differ in contrast:

Non-ossified sarcoma: Osteogenic sarcoma is central bone resorption with several scattered bone fibers. On the periphery, there is a reaction of the periosteum to create images: sun rays, grass, burning grass... Progressing very quickly.

Ossified sarcomas: more common include Chondrosarcoma, sarcoma, Ewing's sarcoma (periosteum), Reticulosa sarcoma and choriocarcinoma. Characterized at the ends of long bones.

There is a speckled contrast image (Cartilaginous sarcoma).

Onion shell (Sac Ewing).

There is bone resorption in the articular cartilage area of ​​the skull, sacrum, very large tumor growth.

Classification of bone tumors according to the patient's age:

Based on the age of the patient, about 80% of bone tumors can be accurately identified.

0.1: Neuroblastoma.

0.1 - 10: U Ewing (in the bony body).

10 -30: Bone sarcoma (in the bone end), Ewing's tumor (beautiful bone).

30- 40:

Reticular sarcoma (histologically similar to Ewing's tumor).

Fibrosarcoma (Fibrosarcoma).

Malignant giant cell tumor (similar to Fibrosarcoma).    

Periosteal sarcoma.


> 40:

The cinoma, metastasis.

Multiple Myeloma

Cartilaginous scab.

Bone metastasis

Of primary origin, common in order





Rectal, sigmoid colon.




Da (Melanoma, Epitheliosarcome).

On radiographs, people classify 2 types of metastases, bone resorption and bone formation

Bone resorption metastasis: has the following characteristics:

Common in long bones, vertebral bodies, pelvis, sacrum.

Boundary unknown, round or oval multifocal (punched shape).

Remove a piece of bone.

Pathological fracture.

Bone metastases:

Common in pelvis and vertebrae.

They are faint clouds, the border is not clear. Formation of dense bones.

In addition, we can see metastases with mixed images of bone resorption and solidification.

Figure: Cranial thickening with multiple foci of bone (Paget's disease).

Figure: Fibroblast dysplasia.

Figure: Brush-shaped skull (Thalassaemia).