1 ALTERATIONS IN BONE SHAPE 1
Generalized alterations in shape 1
Achondroplasia 1
Osteogenesis imperfecta (fragilitas ossium) 2
Chondro-osteodystrophy 3
Acromegaly 4
Muscular paralysis 5
Regional alterations in shape 5
Congenital growth defects 6
Craniocleidodysostosis 6
Arachnodactyly 6
Club foot 6
Gross failure in the development of the hands or feet 6
Congenital wedge-shaped and supernumerary vertebra 6
Spina bifida 6
Fusion of vertebral bodies 8
Regional deformities due to disease 6
Deformity of vertebral bodies 8
Faulty modelling of the long bones 9
Deformity following epiphyseal damage 9
Local bony protuberance 9
Exostosis 9
External chondroma 12
Local bone deficiency 12
Collapse of a single vertebra 13
Spinal osteoporosis with collapse of a single vertebra 13
Vertebral osteochondritis 13
Xanthomatous deposit 14
Traumatic and post-traumatic collapse 14
Hydatid cyst 14
Neoplastic secondary deposit 15
Secondary deposit with disc intrusion 15
Benign tumour 15
Paget＇s disease 15
Developmental defect 16
Tuberculous lession with vertebral collapse 16
Deformity from softening of the bones 17
The pelvis 17
The long bones 18
2 ALTERATIONS IN THE POSITION OF A BONE 19
Congenital elevation of the scapulae 19
Depressed sternum 19
Genu valgus 19
Spondylolisthesis 20
Congenital dislocation of the hip 22
Displaced patella 24
Congenital dislocation of the talus 24
Scoliosis 24
3 ABNORMALITIES IN THE REGION OF THE EPIPHYSES 26
Alteration in the maturity of the epiphyses 26
Acceleration of epiphyseal maturity 26
Retardation of epiphyseal maturity 27
Acceleration or retardation of epiphyseal fusion 28
Generalized alteration in the appearance of the epiphyses 28
Developmental defects 29
Chondro-osteodystrophy 29
Gargoylism 30
Dyschondroplasia or chondrodystrophy 30
Multiple epiphyseal dysplasia (chondrodysplasia) 31
Endocrine epiphyseal defects 32
Hypothyroidism (cretinism) 32
Dietetic epiphyseal disorders 32
Rickets 32
Scurvy 34
Heavy metal deposition in the metahyseal region 35
Abnormality of a single epiphyseal region 36
Osteochondritis of the femoral head (Perthes＇ disease) 36
Slipped upper femoral epiphysis (adolescent coxa vara) 37
Osteochondritis of the tibial tuberosity (Osgood-Schlatter＇s disease) 38
Osteochondritis of a metatarsal epiphysis 39
Osteochondritis of the navicular (Kohler＇s disease) 39
Osteochondritis of the primary centre of a vertebral body (Calvé) 39
Osteochondritis of the secondary centre of a vertebral body (Scheuermann＇s disease) 40
Uncommon sites of epiphyseal fragmentation (osteochondritis，epiphysitis) 40
4 INCREASES IN BONE DENSITY 42
Generalized increase in bone density 42
Developmental osteopetrosis 42
Developmental osteopoikilosis 44
Secondary deposits 44
Myelosclerosis 46
Renal osteosclerosis 46
Hypervitaminosis 48
Fluorosis 48
Paget＇s disease 48
Increase in density of a single vertebra 48
Secondary deposit of carcinoma 48
Hodgkin＇s disease 48
Paget＇s disease 49
Local vascular disorder 49
Low-grade chronic osteomyelitis 50
Benign tumour or developmental defect 50
Primary bone sarcoma 50
Isolated increase in bone density in a limb bone，rib or pelvis 50
Developmental defect 50
Deep bone infarct 50
Healing cyst 52
Avascular necrosis or osteochondritis 52
Dense lunate 52
Dense talus or scaphoid 52
Dense patella 52
Dense femoral head 53
dense terminal phalanx 53
Secondary deposit 53
Sclerosing osteitis and sarcoma 53
Condensans ilii 54
Isolated increase in density in the skull or facial bones 54
Anatomical variations 54
Hyperostosis frontalis 55
Meningioma 56
Inflammatory lesion 56
Secondary deposit 56
Leontiasis ossea 56
Paget＇s disease 56
5 NEW BONE AND CALCIFICATION OUTSIDE THE CORTEX (PERIOSTEAL SHADOW OR PERIOSTITIS) 57
Post-traumatic periosteal shadow 58
Non-traumatic haematoma 58
Stress fracture and fatigue fracture 59
Inflammatory conditions 61
Pyogenic or typhoid bone infections 61
Syphilitic bone lesions 61
Tuberculous bone lesions 61
Fungus infections of bone 62
Benign neoplasm 62
Osteoid osteoma 62
Malignant neoplasm 62
Vascular disorders 63
Varicose veins and arterial occlusion 63
Pulmonary osteoarthropathy 63
Idiopathic hypertrophic osteoarthropathy 64
Melorheostosis (Leri) 64
Diaphyseal dysplasia (Engelmann) 64
6 WIDESPREAD AND REGIONAL DECREASES IN BONE DENSITY 65
Introduction 65
Widespread even decalcification 66
Endocrine disorders 66
Cushing＇s syndrome 66
Cortisone therapy 67
Late stage acromegaly 68
Hyperthyroidism 68
Ovarian agenesia and eunuchoidism 68
Old age 68
Dietetic deficiencies 68
Calcium and phosphorus 68
Vitamin D 68
Vitamin C 69
Protein 69
Alimentary tract disorders 69
Osteomalacia from deficient fat and vitamin D assimilation 69
Looser zone or Milkman fracture in osteomalacia 69
Metabolic disorders－renal osteodystrophy 70
Haemopoietic diseases 71
Leukaemia in children 71
Leukaemia in adults 73
Histiocytosis (Gaucher＇s disease) 73
Myelomatosis 73
Coarsened trabecular pattern associated with decalcification 73
Hyperparathyroidism 73
Hypoparathyroidism 75
Sickle-cell (Cooley＇s) anaemia 75
Alimentary tract disorders 75
Patchy decalcification 77
Secondary neoplasm and myelomatosis 77
Old age 78
Haemopoietic diseases 79
Decreased bone density in one region or group of bones 79
Spinal decalcification 79
Disuse and sepsis decalcification of part of a limb 81
7 A TRANSLUCENT AREA IN A BONE 83
Introduction 83
Well-demarcated translucent area within a bone 83
Simple cysts of uncertain aetiology 83
Osteitis fibrosa cystica (in hyperparathyroidism) 85
Developmental defects 86
Fibrous dysplasia 87
Non-osteogenic fibroma (fibrous metaphyseal defect) 88
Chondromyxoid fibroma 89
Chondroblastoma 89
Aneurysmal bone cyst 89
Tuberose sclerosis (Mesodermal dysplasia) 89
Arterio-venous aneurysm 90
Haemangioma 90
Chondroma or hamartoma 90
Neurofibromatosis 92
Tumours 92
Osteoclastoma 92
Solitary plasmacytoma 92
Secondary deposit 92
Granulomas 94
Xanthomatous granuloma 94
Non-specific granuloma 95
Histiocytosis (Gaucher＇s disease) 95
Sarcoid 95
Infective conditions 96
Tuberculosis 96
Pyogenic infection 97
Fungoid infection 97
Yaws 97
Hydatid cysts 97
Post-traumatic cyst-like translucency 97
Haemophilia with haemorrhagic bone cyst 97
Cyst-like translucency in association with arthritis 97
Well-demarcated translucent area with cortical thinning and gross bone expansion 98
Simple cyst of uncertain origin 98
Hyperparathyroidism (osteitis fibrosa cystica) 99
Developmental defects 100
Monostotic fibrous dysplasia 100
Giant-cell tumour variants 100
Chondroma 100
Neoplasm 101
Osteoclastoma 101
Solitary plasmacytoma 102
Secondary deposit 102
Infection 102
Well-demarcated erosion of the surface of a bone 104
Pressure erosion 104
Pressure from occupation 104
Pressure from an aneurysm 104
Pressure from a neurilemmoma，ganglioneuroma or dilated intercostal arteries 105
Intervertebral disc intrusion (schmorl node) 105
Developmental defect and implantation dermoid 105
Urate deposit 105
Surface absorption of the tip of a terminal phalanx 105
Pyogenic infection 105
Leprosy 105
Trauma 106
Vascular disorders 106
Neuropathic disorders 107
Developmental defect 107
Articular cortex surface erosion－osteochondritis dissecans 108
Poorly-demarcated translucent area within the bone 108
Malignant neoplasm－primary bone or secondary deposit 109
Fibrous dysplasia 110
Haemangioma 110
Xanthomatous granuloma 110
Tuberculous lesion 111
Poorly-demarcated erosion of the surface of a bone 111
Malignant neoplasm 111
Xanthomatous granuloma 112
Tuberculosis 113
A translucent area in the vault of the skull 113
Anatomical variations 113
Depression for a Pacchionian body 113
Emissary veins 114
Diploic venous pool 114
Congenital parietal foramen 114
Developmental defects 114
Meningocoele 114
Fibrous dysplasia 114
Haemangioma 114
Intradiploic dermoid and epidermoid 114
Extracranial dermoid 114
Acquired lesions 115
Post traumatic cyst-like area 115
Post radiation necrosis 115
Hyperparathyroidism 115
Xanthomatosis granuloma 115
Infective conditions 115
Direct trauma 115
Secondary deposit 115
Response to an intracranial lesion 116
Meningioma 116
Direct invasion from scalp neoplasm 116
Rodent ulcer 116
Carcinoma 116
8 COMBINATION OF SHADOWS 117
Periosteal opacity and erosion 117
Pyogenic inflammation 117
Tuberculous inflammation 121
Syphilis 121
Fungus infection 123
Actinomycosis 123
Madura foot 124
Blastomycosis 124
Coccidioidomycosis 124
Cysts and inocent tumours 124
Malignant neoplasm 124
Malignant bone tumours with much erosion 124
Malignant bone tumours with much calcification 127
Malignant bone tumours with much periosteal new bone 128
Differential diagnosis 129
Periosteal shadow and sclerosis 130
Low-grade chronic osteomyelitis 131
Diaphyseal dysplasia (Engelmann) 131
Osteoid osteoma 132
Syphilis 132
Malignant neoplasm 132
Periosteal opacity with erosion and sclerosis 132
Chronic osteomyelitis 132
Sequestra in osteomyelitis 132
Chronic localized bone abscess 133
Osteoid oesteoma 133
Malignant neoplasm 134
9 ALTERATIONS IN THE BONE ARCHITECTURE 135
Paget＇s disease 135
Paget＇s disease and sarcoma of bone 137
10 ALTERATIONS IN JOINT SPACE (ARTHRITIS) AND ASSOCIATED BONE CHANGES 139
Introduction 139
The diminished joint space 139
Associated bone changes 139
Difficulties of classification 139
Arthritis of known cause 140
Pyogenic arthritis (septic arthritis) 140
Gonococcal arthritis 141
Virus arthritis 141
Tuberculous arthritis 141
Haemophilia with arthritis (haemorrhage into a joint) 145
Arthritis of unknown cause 145
Classical rheumatoid arthritis 145
Unusual manifestations of rheumatoid arthritis 148
Unusual distribution of affected joints 148
Unusual age of onset 149
Milder type of lesion 149
Unusual radiographic appearances 150
Arthritis in association with other diseases 150
Arthritis with psoriasis 151
Arthritis with ulcerative colitis 151
Arthritis with non-specific urethritis 152
Arthritis with rheumatic fever 152
Arthritis with systemic lupus erythematosus 152
Ankylosing spondylitis 152
Arthritis of partly-known origin 154
Degenerative or osteoarthritis 154
Intra-articular loose bodies 156
Neuropathic arthritis 157
Metabolic defect with arthritis 157
11 SOME HINTS ON χ-RAY TECHNIQUE 159
Plain radiographs 159
To acquire good detail 159
To acquire good contrast 159
Measurement of bone length 159
Tomography 160
Selection and spacing of layers 160
Simultaneous multisection tomography 160
Value oftomography 161
Injection of simuses 163
Avoidance of excessive radiation 163
12 BONE IN UNUSUALSITES AND CALCIFICATIONS IN OR NEAR A JOINT 164
Bone in muscle and tendons 164
Ossification in a tendon 164
Myositis ossificans 164
Calcifications in structures or near a joint 164
Calcification in a joint cartilage 164
Calcification in a joint capsule 165
Calcification in a joint ligament 165
Calcification in the supraspinatus tendon 165
Calification near the finger joints 166
Calcification in tuberculous synovitis 166
Calcification in a bursa over a joint or a synovial cyst 166
APPENDIX 167
REFERENCES 170
INDEX 171