Question

Discuss the imaging features of scurvy on a plain radiograph.

Hint:

In scurvy, widening of growth plates, subperiosteal hemorrhage, and the scorbutic rosary are characteristic radiographic findings that indicate vitamin C deficiency.

Answer 1

Step 1: Introduction to Scurvy.
Scurvy is a disease caused by vitamin C deficiency, which leads to collagen synthesis defects, resulting in symptoms like bleeding gums, fatigue, muscle weakness, and skin changes. The condition also affects bone health, which can be evaluated through plain radiographs. Plain radiographs are often used to detect the bone abnormalities associated with scurvy, particularly in children. Scurvy can lead to subperiosteal hemorrhages, bone resorption, and fractures, which are visible on X-ray imaging.
Step 2: Imaging Features of Scurvy on Plain Radiographs.
(1) Widening of the Growth Plates: - One of the early findings in scurvy, particularly in children, is widening of the growth plates due to failure of cartilage maturation. The metaphyseal regions of the bones appear widened or flared, especially in long bones such as the femur and tibia. (2) Subperiosteal Hemorrhage: - Subperiosteal hemorrhage is a hallmark of scurvy and appears as fluffy, soft tissue opacities adjacent to the bone. This occurs due to the fragility of blood vessels around the bones in the absence of adequate collagen. It typically affects the distal femur, tibia, and radius. (3) Pelkin’s Fractures (Cortical Fractures): - In scurvy, subperiosteal hemorrhages may lead to cortical fractures known as Pelkin's fractures. These appear as transverse fractures involving the cortex of the long bones, often without much displacement. These fractures are commonly found in the tibia, femur, and humerus. (4) Scorbutic Rosary: - The scorbutic rosary is a term used to describe the prominent costochondral junctions visible on X-ray, particularly in the ribs. This occurs due to osteoid accumulation at the costochondral junction, which is caused by impaired collagen formation. (5) Ground Glass Appearance: - The ground-glass appearance of the metaphysis, especially in the distal femur and proximal tibia, is another feature of scurvy. This is indicative of osteopenia or bone density loss due to impaired bone mineralization. (6) Fractures and Osteopenia: - Bone resorption and osteopenia (reduced bone density) may lead to spontaneous fractures, especially in weight-bearing bones. These fractures are typically non-traumatic and occur more easily in the context of scurvy.