Periosteal elevation in childhood and cortical thickening

Periosteal elevation may be physiologic in rapidly growing infants - this type of periosteal elevation is characteristically uniform, not very thick and involves the femora, tibias, and humeri but rarely other bones. There are many pathologic causes including healing rickets (Fig. 68 b), Caffey disease, prostaglandin therapy, leukemia, tumors, infection, vitamin A poisoning and trauma.

Caffey disease

This is an idiopathic disorder of bone which is associated with tenderness and swelling along the bones. There is considerable cortical thickening or periosteal elevation. The mandible is frequently but not always involved. Both flat bones and tubular bones can be affected. The condition usually occurs within the first six months of life. It is often seen at birth or even in utero. There may be elevated levels of prostaglandin present. The infant's symptoms may be relieved by prostaglandin antagonists. The condition is usually self limiting and is treated by conservative means.

Prostaglandin therapy

Periosteal elevation may occur from administration of prostaglandins to keep the ductus arteriosus open in infants with severe cyanotic heart disease prior to definitive therapy such as heart transplants. The periosteal change in the bone can be extensive not unlike those seen in Caffey disease, particularly if the treatment is prolonged.

Andrew K. Poznanski