分析nyu cases peds 1儿科病例25.pdfVIP

Rickets ◼ Case findings: ◼ Diffuse osteopenia, widened growth te ◼ Femoral and tibial metaphysis are frayed and cupped ◼ Enlargement of the anterior aspect of the ribs at the costochondral junction (rachitic rosary) ◼ Other findings (not shown): coxa vara, basilar invagination of the skull, bila l acetabula protrusio in the pelvis, sabre shin deformity with anterior bowing of the tibia, scoliosis ◼ Disorder of bone mineralization: osteoblastic activity and production of bone matrix continue but matrix mineralization is delayed Case directory Rickets ◼ Etiology of abnormal vitamin D metabolism: ◼ Lack of sunlight exposure ◼ Malabsorption, inadequate dietary intake of vitamin D ◼ Renal osteodystrophy, renal tubular loss of phosphate, RTA, Fanconi syndrome ◼ Rickets of prematurity ◼ Anti-convulsant drugs ◼ Hypophosphatasia ◼ Liver disease Case 2 Langerhans cell histiocytosis ◼ Case findings: ◼ Osteolytic lesions with well defined, sclerotic margin ◼ Classic: beveled edge involving inner table on CT of calvarium ◼ DDX solitary lytic lesion in the skull: ◼ Metastatic lesion ◼ LCH ◼ Fibrous dys sia ◼ Tuberculosis ◼ Trauma (leptomeningeal cyst) ◼ Osteomyelitis ◼ Epidermoid, dermoid ◼ Myeloma (rare in a child) Case directory Langerhans cell histiocytosis ◼ Eosinophilic granuloma (EG –this case): ◼ Benign self limiting unifocal disease involving lytic lesions of bones hildren and young adults ◼ Hand Schuller Christian: ◼ Children and young adults ◼ Multifocal disease involving bones and soft tissues ◼ Triad: proptosis, lytic bone les