JSS Medical College, Mysuru

Imaging in Scurvy

-Dr.ShilpaResident,

JSS Medical College ,Mysuru

Please visit www.jssmcradiology.com for more Radiology education

For more Radiology Education visit www.jssmcradiology.com

JSS Medical College, Mysuru

Introduction..

(Barlow’s disease, hypovitaminosis C)

• Pathology:• Vitamin C necessary for Endothelial lining : deficiency

causes increased vascular fragility• Decreased osteoblastic activity and cartilage proliferation

resulting in decreased formation of bony matrix• Normal mineralisation• Osteoporosis

JSS Medical College, Mysuru

Radiologic features1.Dense zone of provisional calcification (white line of

Frankel).

2.Corner (angle) sign-Corner (angle) sign.

Irregularity of the metaphyseal margins frequently

occurs secondary to infarctions of the epiphyseal-

metaphyseal junction.

3. Pelken’s spurs.

4. Scorbutic zone (Trümmerfeld’s zone).

5.Subperiosteal hemorrhage.

JSS Medical College, Mysuru

PA Knee:

Characteristic changes:

1. Generalized osteopenia,

2. Dense zone of provisional calcification,

3. Scorbutic zone,

4. Pelken’s spurs ,

5. Wimberger’s sign (ring epiphyses) and

6. Subperiosteal hemorrhages

JSS Medical College, Mysuru

WHITE LINE OF FRENKEL• White line in the zone of provisional

calcification at the growing metaphysis

• Dense zone of provisional calcification (white line of Frankel).

• Cartilage proliferation decreased with normal mineralisation resulting in widened and dense zone of provisional calcification

JSS Medical College, Mysuru

WIMBERGER SIGN• Epiphysis is small sharply

marginated by sclerotic rim with central portion more radiolucent.

• Due to decrease cartilage proliferation and unimpaired mineralization (sclerosis)

JSS Medical College, Mysuru

TRUMMERFELD ZONE (SCORBUTIC ZONE)

• Transverse radiolucent band adjacent to zone of provisonal calcification due to suppressed osteoblastic activity with normal mineralisation

• Trabecular bone mass is decreased in zone of primary and secondary spongiosa. Scorbutic zone (Trümmerfeld’s zone).

JSS Medical College, Mysuru

PELKAN’S SPUR

• Zone of provisional calcification extends

beyond the margins of the metaphysis

resulting in periosteal elevation and marginal

spur formation

• These bony protuberances occur at the

metaphyseal margins and extend at right

angles away from the shaft axis.

JSS Medical College, Mysuru

CORNER (ANGLE) SIGN

• Irregularity of the metaphyseal margins secondary to infractions of the epiphyseal-metaphyseal junction

JSS Medical College, Mysuru

SUBPERIOSTEAL HEMORRAGES

• Due to increased capillary permeability

• Seen in ends of long bones(femur,tibia, humerus)

• May cause periosteal elevation and new bone formation

JSS Medical College, Mysuru

Thank You

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