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PubMed1997

Periosteal new bone formation in the jaws. A computed tomographic study.

OBJECTIVES: To investigate the diagnostic significance of a periosteal reaction (PR) in diseases of the jaws. METHODS: The frequency of PR was investigated in 1142 patients who had undergone CT of the maxilla or mandible. The pattern of PR was categorized as either parallel, irregular, spicule or Codman's triangle. We examined the relationship of the pattern of PR to the specific disease categories of osteomyelitis, trauma, cysts, benign tumours and malignant tumors. RESULTS: Seventy patients were found to have PR. It was found in 40% of cases with osteomyelitis and 15% of malignant tumors. The only benign lesion was an eosinophilic granuloma. There were no cysts. The frequency of PR was higher in younger patient and in those with sarcomas or bone metastases compared with those with carcinomas. Ninety-one percent of the patients with osteomyelitis showed single or multi-layered PR parallel to the cortical bone, while 61% of those with malignant tumors had a spicule pattern. With the exception of Codman's triangle, none of the PR patterns were specifically associated with any one disease category. When the PR pattern was combined with the pattern of cortical bone destruction, 90% of the patients with PR could be correctly assigned to one or other of the four disease categories of osteomyelitis, trauma, benign lesion or malignant tumor. CONCLUSIONS: The pattern of PR on CT in combination with the pattern of the cortical destruction of the cortex is useful in differentiating osteomyelitis from malignant tumors.

Adult↗
PubMed1999

Florid reactive periostitis of the middle phalanx: a case report and review of the literature.

Florid reactive periostitis is an uncommon bone lesion that occurs most often in the phalanges of the hands and feet. Histologic evaluation is commonly required to distinguish this benign lesion from clinically indistinguishable malignant and infectious etiologies. While the lesion is typically self-limiting or cured by simple excision, we report a case of aggressive recurrence following an excisional biopsy that ultimately led to ray amputation.

Adult↗
PubMed1987

Breast cancer presenting as periostitis.

A previously healthy 69-year-old woman presented with progressive and unremitting distal leg pain that was confirmed by biopsy to be periostitis. Ten months after the onset of symptoms, carcinoma of the breast was diagnosed. Surgical removal of the neoplasm was followed by complete relief of leg pain within 24 hours. Hypertrophic osteoarthropathy must be considered in adult patients presenting with unexplained joint or distal extremity symptoms, and a vigilant search for underlying malignancy should be undertaken.

Aged↗
PubMed1992

Chronic abdominal pain due to periostitis pubis. A new syndrome.

Periostitis pubis is a clinical syndrome previously undescribed in the literature. It is characterized by lower abdominal pain that may have persisted for several weeks to several years. Physical findings are limited to tenderness in one of the lower abdominal quadrants and over the os pubis on the affected side. The diagnosis can be confirmed by injecting lidocaine hydrochloride into the area of point tenderness over the os pubis, which should relieve tenderness in both sites. An elaborate laboratory workup is not necessary. The condition can be cured with an injection of prednisolone tebutate at the site of tenderness over the os pubis.

Abdominal Pain↗
PubMed2002

Sclerosing osteomyelitis of Garré periostitis ossificans.

Sclerosing osteomyelitis of Garré is a rare syndrome; the mandible is the most commonly affected bone segment in the cervicofacial region. This chronic disease is characterized by a nonsuppurative ossifying periostitis with subperiosteal bone formation, commonly reactive to a mild infection or irritation. The differential diagnosis must be made with similar clinical conditions with hard mandibular swelling associated with bony sclerosis. Presumptive diagnosis can be achieved by radiology, but such diagnosis must be confirmed by histology. The aim of therapy is to remove the cause when recognized, aided by an adequate antibiotic therapy. Clinical, radiographic, and histologic features are presented in this case report.

Adolescent↗
PubMed2005

Idiopathic myelofibrosis with generalized periostitis in a 4-year-old girl.

Idiopathic myelofibrosis, a chronic myeloproliferative disorder of unknown origin, is characterized by splenomegaly, extramedullary hematopoiesis, leukoerythroblastosis, teardrop erythrocytes, and myelofibrosis. It is a rare disorder in childhood. The authors describe a 4-year-old girl with features consistent with idiopathic myelofibrosis, who also had generalized solid laminated periosteal reaction involving all long bones. The presence of thrombocytopenia at the onset and lack of leukocytosis were in contrast to the reported features seen in children. Recent case reports describe a relatively indolent course in children. Spontaneous remissions have also been described in pediatric cases. The fulminant course of this patient without any features of malignant transformation was noteworthy in this regard.

Bone Marrow↗
PubMedDate not supplied

Pseudomalignant tumor after biopsy of periostitis.

Periosteal reaction is a commonly encountered radiographic finding. Differential diagnoses include trauma, infection, and neoplasia. Biopsy may be necessary for the definitive diagnosis. Surgical trauma to an inflamed periosteum can stimulate a rapid and tremendous bone-forming response.

Biopsy↗
PubMed1993

Mandibular central giant cell granuloma associated with sclerosing osteomyelitis of Garrè (periostitis ossificans). Case report.

Garrè's sclerosing osteomyelitis or periostitis ossificans with a radiographic 'onion skin' appearance is a separate clinical entity. The new bone formation underneath the periosteum is a response of periosteum to stimulation by low grade infection. This may occur in a variety of other developmental, metabolic, inflammatory and neoplastic diseases of bone. A case of mandibular giant cell granuloma of a central type associated with Garrè's sclerosing osteomyelitis is presented and the literature is reviewed.

Child↗
PubMed2001

MR Imaging of sports-related pseudotumor in children: mid femoral diaphyseal periostitis at insertion site of adductor musculature.

OBJECTIVE: The objective of this study was to review the imaging appearance of the femurs of five patients who had been referred from outside institutions after presenting with thigh pain and being given a preliminary diagnosis of primary malignant bone tumor. Typically, when making a diagnosis, physicians place emphasis on the characteristic appearances of diseases on MR imaging, but such appearances may be misleading. An awareness of the specific MR imaging pattern of stress-related partial muscle avulsion can lead to the correct diagnosis. CONCLUSION: Femoral diaphyseal periostitis after a sports injury to the adductor musculature in children has a characteristic imaging appearance. This condition can initially appear to be misleadingly aggressive. Knowledge of the findings-particularly of the findings on MR imaging-in the proper clinical setting can help physicians make the correct diagnosis and eliminate unnecessary biopsy or inappropriate treatment.

Adolescent↗
PubMed1995

Psoriatic onycho-periostitis. Report of three cases.

Authors report three cases of psoriatic onycho-periostitis (great toe in two cases, thumb in one case). In a recent study, they demonstrated that osteoperiostitis of the distal phalanx of the great toe was significantly more frequent in patients with psoriatic arthritis than in other groups (cutaneous psoriasis, rheumatoid arthritis, spondylarthropathy, connective tissue diseases, and control subjects), suggesting that the existence of osteoperiostitis of the distal phalanx of the great toe is valuable for the diagnosis of psoriatic arthropathy.

Adult↗
PubMed1979

[Periosteal reactions in bone tumors (author's transl)].

Morphology of solid, lamellar and spicular periosteal reactions of benign and malignant primary and metastatic bone tumors in x-ray-pictures with regard to common and specific characteristics of different bone tumors is presented. The specific behaviour of the periosteum itself and of the subperiosteal region as an expression of the reactive biodynamics in skeletal neoplasia is demonstrated; and the diagnostic value of the radiograph is explained. The possibilities but also the limitations of sophisticated radiologic image analysis in establishing a differential diagnosis and a diagnosis of bone tumors and other bone lesions are discussed.

Adult↗
PubMed1992

[Recombinant human granulocyte-colony stimulating factor (rhG-CSF) treatment for spleen abscess and periostitis in a patient with chronic granulomatous disease].

A 9-year-old boy with chronic granulomatous disease was hospitalized on May, 1991, because of continued fever and pain in the right elbow. Increased bone intensity at the distal end of right humerus on x-ray and a 33 x 36 mm space-occupying lesion in the spleen on abdominal CT scan were recognized. Under a diagnosis of periosteitis and spleen abscess, intravenous infusion of rhG-CSF at a dose of 200 micrograms/m2/day was started in combination with antimicrobial therapy. Fever, tenderness, swelling in the right elbow and inflammatory indices improved three weeks after the institution of therapy. Hydrogen peroxide (H2O2) formation by neutrophil increased significantly, although intermittently, during the therapy. The spleen abscess had completely vanished on CT scan on February, 1992. The therapy was well tolerated and no significant side effects were observed. The use of rhG-CSF in combination with potent antibiotics is recommended for patients with serious infections in chronic granulomatous disease to avoid a fatal course.

Abscess↗
PubMed2005

[Clinical-microbiological evaluation of the efficacy of combined use of chitosan, low intensity laser radiation and photosensitizer in treatment of patients with acute suppurative maxillofacial periostitis].

Results are presented on treatment of 68 patients with acute suppurative periostitis of maxillofacial region. After surgical interventions in patients of the study group (48 patients) the wounds were cleansed by 1% chitosan on 0.2% HC1 in combination with methylene blue and irradiated by IR laser beam. The wounds healed in 2-3 days. In the control group (20 patients) for wound dressing chlorhexidine as a standard procedure was used, length of the healing process was 5-6 days. After combined treatment the number of microflora in the wound was reduced and microflora did not show the signs of pathogenicity.

Adolescent↗
PubMed2006

Psoriatic onycho-pachydermo-periostitis successfully treated with low-dose methotrexate.

BACKGROUND: Psoriatic onycho-pachydermo-periostitis (POPP) is a rare manifestation of psoriatic arthritis that is often misdiagnosed as a nail infection. The treatment for POPP has not yet been established. CASE REPORT: We present a case of a 67-year-old man who had no psoriatic skin lesions with POPP, characterized by psoriatic nail changes, painful swelling of the distal soft tissues on the great toes and fingers, and enthesopathies of the involved terminal phalanges. The clinical nail and arthritic changes were improved with methotrexate treatment 4 mg weekly for 6 months. CONCLUSIONS: Methotrexate can be recommended as the first-choice therapeutic agent for patients with POPP.

Aged↗
PubMed1979

Proliferative periostitis of Garré: its differentiation from other neoperiostoses.

A review of 15 well-documented cases of proliferative periostitis reported in the literature and a description of six new cases, five fully documented, have shown the following: a variety of irritants both odontogenic and nondontogenic in origin may induce neoperiostosis in the mandible; radiographically, cortical redundancy and preservation of the original cortical outline are the most common findings; and microsocopically, a fibro-osseous pattern evincing one of the three trabecular orientations--parallel, retiform, or haphazard fibrous dysplasia-like--is featured. If other complicating factors are absent, after the suspected source of irritation has been eliminated, resolution takes place in six to 12 months in most instances.

Adolescent↗