Musculoskeletal Imaging

Periostitis

inflammation of the periosteum, leading to tenderness and swelling with aching pain. Often striking bone proliferation is noted. Periostitis may involve only a limited region, as in cases of infection, or may be diffuse. Table 1 lists some causes of diffuse periostitis.

Periostitis, Table 1. Some causes of diffuse periostitis and periostitis involving multiple sites.

Primary hypertrophic osteoarthropathy (pachydermoperiostosis)

Secondary hypertrophic osteoarthropathy

Thyroid acropachy

Venous stasis

Hypervitaminosis A

Infantile cortical hyperostosis (Caffeys disease)

Fluorosis

Leukaemia

Vascular insufficiency

Infection

Trauma

Florid reactive periostitis occurs in the hands and feet and is characterized by exuberant periosteal bone formation, a soft tissue mass with calcification or ossification, and pain, swelling, tenderness or redness. The radiographic features are compatible with those of myositis ossificans or pseudomalignant osseous tumour of soft tissue (Fig.1) (Fig.2).

Children who have suffered traumatic child abuse may show periostitis on radiographs, although often this finding is delayed.

Periostitis accompanies Leukaemia and is usually prominent in long tubular bones. A similar appearance may be noted in syphilis and after prostaglandin therapy.

Other conditions in which periostitis occurs are juvenile chronic arthritis (most commonly in phalanges, metacarpals and metatarsals), psoriatic arthritis, leprosy, bone metastases, Crohns disease, POEMS syndrome, scleroderma, frostbite, Hodgkins disease and diffuse idiopathic skeletal hyperostosis DISH , among many others.

DR/RB

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Fig.2

AP radiograph of the foot demonstrates periosteal reaction surrounding the second metatarsal owing to florid reactive periostitis.


Periostitis, Fig.1		Periostitis, Fig.2