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Reactive periostitis of the hand can be a confounding lesion on both radiological and histological grounds. An erroneous diagnosis of a malignant tumor, particularly an osteosarcoma, is a possibility. Two cases of florid reactive periostitis of the hand mistaken for osteosarcoma are reported here to illustrate this entity and caution against a diagnostic pitfall.
UNLABELLED: We report a boy with a new form of mesomelic dysplasia characterised by short stature, multifocal periosteal thickening, radio-humeral dislocation, osteoporosis and multiple fractures with minimal trauma. Electrophoresis of fibroblast collagens detected defects in type III and type V collagen. CONCLUSION: Bone dysplasias presenting with osteopenia, abnormal trabecular pattern, bone fragility, and periosteal thickening suggest a collagenopathy. A possible collagen defect requires biochemical investigations.
Ninety-three clinically and radiologically diagnosed cases of periostitis ossificans were gathered over a 13-year period. Histologic specimens were available in 19 cases. The predominant age, race, and gender were determined. The position of the periosteal reaction, its average length and width, and radiographs required to best demonstrate it were also established. Sequestra were present in two thirds of the cases. Radiographic features and associated clinical findings are described.
An 11-year-old boy developed florid reactive periostitis several years after minor trauma. The symptoms responded initially to antibiotics, but after cessation, rapidly recurred and progressed, requiring a ray amputation to relieve the pain and to achieve a functional hand. The reactive periostitis affected the volar aspect of two adjacent phalanges with sparing of the intervening joint, confirming that this is a reactive process rather than a benign neoplasm.
A case of florid reactive periostitis of the thumb is presented. This is a rare pseudosarcomatous lesion which generally has a benign radiographic appearance, but on histology it may be mistaken for a malignant process. The clinical behaviour may simulate a malignant tumour but after local excision there is very little propensity for recurrence. Local resection is the recommended treatment. Surgeons and pathologists should consider the possibility of florid reactive periostitis before making a diagnosis of sarcoma in the hand.
Florid reactive periostitis is a rare benign bone lesion that occurs most often in the phalanges of hands and feet. Histologic evaluation is commonly required to distinguish this benign lesion from clinically indistinguishable malignant and infectious disorders. The lesion is typically self-limiting or cured by local excision; however, in very aggressive cases ray amputation may be indicated. The authors report a case of florid reactive periostitis affecting the thumb with satisfactory outcome and without recurrence at 2-year follow-up.
Two case reports of recurrent multifocal periostitis in two girls aged 15 and 6 are added to the eight cases already reported in the literature. The disease is characterized clinically by recurrent mesomelic swelling of the extremities and radiologically by periosteal thickening and sclerosis of underlying bone. Hyperglobulinaemia is the most constant biochemical finding. The bone biopsy shows no typical features. The possibility of a viral etiology is discussed.
Proliferative periostitis of Garré is described as a productive and proliferative inflammatory response of periosteum to infection or other irritation. This can be odontogenic or non-odontogenic in nature. This is a case report of an odontogenic periostitis resulting from periapical inflammation of endodontic origin. It was successfully treated by nonsurgical endodontics. Antibiotic therapy was not used during the treatment of this patient.
Periostitis ossificans is a rare condition which has not been previously reported arising from an infected dentigerous cyst. This paper reports such a case in a twelve-year-old boy, and reviews the literature concerning periostitis ossificans.
Increased metabolic activity with the periosteum is demonstrated radiographically by the presence of a linear shadow of bone paralleling the cortex, most commonly reflecting increased osteoblastic activity and thus representing periosteal new bone. This is frequently seen in psoriatic arthritis and Reiter's syndrome. A similar picture occurs with increased osteoclastic activity and reflects rapid demineralization, simulating periostitis. This change must be recognized as a reflection of osteoporosis, lest the condition be misdiagnosed as inflammatory disease.
A 36-year-old man presented for an HIV test, which answered positive. He gave a six-week history of headache and fever. His syphilis serology was also positive with a Venereal Disease Research Laboratory (VDRL) titre of 1:32, and positive Treponema pallidum particle agglutination (TPPA) assay and fluorescent treponemal antibody (FTA). When he attended for treatment of the syphilis, he had developed severe pain in both lower limbs. Plain radiographs were normal. An isotope bone scan showed multiple areas of increased uptake, consistent with syphilitic periostitis. Some of these lesions were asymptomatic. He was treated with benzathine penicillin and his pain resolved. The bone scan had normalized after six months. We review the previous literature regarding syphilitic bone pain and periostitis. We discuss the importance of considering syphilis in the differential diagnosis of any sexually active adult presenting with bone pain, and highlight the usefulness of isotope bone scans in clarifying the clinical picture.
Periostitis ossificans in the mandible of a 9-year-old girl was assessed by means of computed tomography. Impaired mandibular function was the most consistent clinical sign and led on to referral for suspicion of a temporomandibular joint disease. Her symptoms improved with antibiotic therapy over a period of 2 months. During this time follow-up computed tomography demonstrated a more or less complete resolution of the new bone formation. The aetiology of the periostitis was considered non-dental due to haematogeneous spread from a pharyngitis.
Periostitis of the mandible has not been previously discussed in the otolaryngologic literature and only infrequently in the dental literature. It is characterized by a hard, painless, fixed mass overlying the mandible in a child or young adult. The etiology is usually an endosteal infection in the molar region with periosteal inflammation. Reactive new bone is deposited beneath the elevated periosteum, external to the outer cortex of the jaw, and separated from it by a layer of suppurative fluid. Treatment consists of removal of involved teeth and infected bone, drainage of the fluid pocked and appropriate antibiotics. Patients are followed with repeat X-rays and erythrocyte sedimentation rates. A case is presented and the world literature is reviewed. The otolaryngologist should be aware of this entity and include it in the differential diagnosis of any fixed jaw mass to avoid mistaking it for a more malignant process with unfortunate consequences.
We present three cases of intramuscular haemangioma adjacent to bone in the lower limb. All patients had local pain during the third decade. Plain radiographs showed an irregular or hypertrophic periosteal reaction on the shaft of the fibula and an intramuscular mass adjacent to the bone with inhomogeneous high signal intensity on MRI. These lesions mimic periosteal or parosteal tumours.
Periostitis ossifications ("Garrè's osteomyelitis") of the mandible is a rather rare pathology that occurs as a hard swelling at the mandibular angle, persists for a long period, and is mostly painful on palpation. Clinical signs of infection are rarely noted. The etiological factor is generally a carious first permanent molar with a periapical infection or a fracture of the jaw. In this case, a 10 year-old girl showed a fixed painful swelling of the right mandibular angle. This revealed to be periostitis ossificans, although none of the classical causes were present. The symptoms were evoked by a periodontal infection: there was an osseous crater and a probing pocket depth of more than 10 mm disto-lingually of the first right permanent molar of the mandible. This was likely the etiological factor. Extraction of the first and second permanent right molar, curettage of the corresponding alveoli, and antibiotic treatment resulted in complete healing, clinically and radiologically, after 9 months.
A brother and sister with multifocal recurrent periostitis are presented. Their disease started at an early age and manifested itself as an episodic migrating arthropathy. At roentgenography, reversible solid periosteal reactions were visible along large tubular bones. Scintigraphic and histological investigations revealed a sterile osteitis and thickened periosteum, but there was no indication of a viral infection. The girl experienced spontaneous amelioration after puberty; the boy improved markedly on colchicine.
Symmetrical exuberant periostitis is a rare disease caused by variety of infectious and non-infectious causes. Treponematosis is one of the rare causes of this condition. We report a patient who presented with left arm swelling, secondary to onion peel periostitis of the humerus, which was caused by Treponema species.
Capillaries and tissue leukocyte cytograms in soft gingival tissues were examined by optic microscopy in patients with acute purulent periostitis of the jaws treated by different methods. Disorders in the lymph outflow from gingival tissues were detected, which were due to dilatation of the lymph vessels and interstitial spaces in the mucosal lamina propria and stasis with leukocyte aggregation and purulent clots in the lumina of many lymph vessels. Less pronounced dilatation of interstitial spaces and lymph vessels, higher counts of lymphocytes, monocytes, and macrophages in the tissues of the gingival mucosa lamina propria, observed 2 days after the beginning of adsorption therapy of the subperiosteal abscess cavity, indicate that this therapy is more effective in acute purulent periostitis than traditional treatment.