radiology Osteochondritis dessicans caisson disease caffey’s disease

1. OSTEOCHONDRITIS ,Caisson disease,OSTEOCHONDRITIS ,Caisson disease,
Caffey’s diseaseCaffey’s disease

2. ??????

3. OSTEOCHONDRITIS DESSICANSOSTEOCHONDRITIS DESSICANS
 Misnomer.
 Refers to post-traumatic osteochondral/chondral
fractures.
 Occuring at articular surface.

4.  After injury---detached portion
* remain in situ.
*Mildly displaced.
* Become loose body.
(most common cause of loose body in young
adults is OCD)

5.  Fragmented part—avascular
 Bed of defect ---vital

6. SITES INVOLEDSITES INVOLED
 CONVEX ARTICULAR SUFACES:
 Medial femoral condyles.
 Capitellum of humerus.
 Trochlear surface of talus.

7.  RARE SITES OF INVOLVMENT:
 Shoulder—humeral head ,glenoid.
 Scaphoid.
 Navicular.

8. INCIDENCEINCIDENCE
 M:F =2:1.
 One third cases are bilateral.
 Adolescence.

10. RADIOGRAPHIC FEATURES.RADIOGRAPHIC FEATURES.
PLAIN RADIOGRAPHS
 May be normal.
 When visible
=radiolucent ring surrounding bony fragment.
=in profile-loose body opposite to pit in bone.
Loss of sharp cortical line of articular surface.

11.  CT FINDINGS
Usually axial cuts.
For cortical defects & loose bodies.
Island of bone demarcated by rare field zone.

12.  MRI FINDINGS
vitality of underlying bone
integrity of overlying cartilage.
 NUCLEAR MEDICINE
Non specific mild to moderate increased uptake
of isotope in involved bone.

13. MRI CLASSIFICATION OF OCDMRI CLASSIFICATION OF OCD
 STABLE
* articular cartilage is breached.
*marrow edema.
 UNSTABLE
*pocket of fluid around undetached ,undisplaced
fragment.
*displaced osteochondral fragment.

14. X-ray knee frontal view---radiolucent line on lateral aspect
of medial condyle extending up to articular surface. Joint
space normal.

15. Lateral radiograph of the knee reveals a calcified loose
body (white arrowhead) in the infrapatellar fat pad and
lucency in the articular surface of the patella (black
arrowhead).

16. Ankle frontal view---radiolucent line on dome of talus
,medial aspect. resulting in detachment of fragment. No
displacement.

17. Axial CT of the knee demonstrates a completely detached
osteochondral fracture (arrowhead) in the lateral aspect of
the medial femoral condyle.

18. Coronal CT of the ankle demonstrates a nondisplaced
osteochondral fragment

19. CT ankle axial cuts.OCD of talar dome.

20. T1W & STIR---coronal & sagittal.unstable.

21. Stable –adjacent edema

22. Stable OCD –coronal & sagittal T2W shows lesion of
medial condyle and marrow edema .

23. Coronal T2W unstable OCD with fluid at base of
lesion

24. ??????

25. CAISSON DISEASECAISSON DISEASE
 DYSBARIC OSTEONECROSIS.
 exposure to hyperbaric atmosphere.
 Undersea diving ,space craft.
 Result in decompression sickness.

26. MECHANISMMECHANISM
 Nitrogen bubbles liberated from bone marrow –
bone infarct by small blood vessel occlusion
 Resultant osteonecrosis..
 Shoulder most commonly involved.

27. PresentationPresentation
 Joint pain
 Motion aggravates pain.

28. RADIOGRAPHIC FINDINGSRADIOGRAPHIC FINDINGS
 Juxta articular defects
transradiant subcortical band.
collapse of articular cortex.
sequestration of articular cortex.
secondary osteoarthritis.

29.  Neck and shaft lesions
dense areas.
irregular calcified areas.
COMPLICATION
1. Malignant fibrous histiocytoma.

33. ??????

34. CAFFEY’S DISEASECAFFEY’S DISEASE
 INFANTILE CORTICAL HYPEROSTOSIS.
 Unknown etiology
 In twins ,siblings & cousins.
 Remission & relapses with patchy distribution of
lesion.

35. SITESSITES
 Mandible.
 Ribs.
 Clavicle.
 Scapulae.
 No spine involvement.
 Diapysis involvement.

36. PRESENTATIONPRESENTATION
 Child upto 1 year.
 High grade fever & hyperirritability.
 Painful deep soft tissue swelling. occur before bone
lesion appear.

37. RADIOGRAPHIC FEATURESRADIOGRAPHIC FEATURES
 Marked periosteal proliferation.
 Cortical thickening.
 Soft tissue swelling.

38. OUTCOMEOUTCOME
 Bone returns to normal by 12 weeks.

39. Osteoblastic periosteal lesion involving shaft of ulna
,also lateral aspect of radius.

40. Deformity, periosteal reaction. Soft tissue
swelling.