This document discusses scurvy, a nutritional disorder caused by vitamin C deficiency. It presents the clinical features and radiological findings of scurvy, including generalized hemorrhage, skeletal lesions, delayed wound healing, and anemia. Radiological findings include osteoporosis, subperiosteal hemorrhage, increased calcification around the epiphysis (Wimberger's ring sign), cortical thinning (pencil point cortex), and fragmentation above the calcified cartilage in the metaphysis (Trummerfeld's zone). Treatment involves oral or parenteral vitamin C, with loading doses of 500-1000 mg daily for one week for clinical scurvy.

1. S C U R V Y
IMAGING IN
Moderator Dr. Sandeep
Presented by Dr. Ravindra

2. SCURVY IN INFANT “BARLOW DISEASE”
DEFINITION
‣ Nutritional disorder caused by de
fi
ciency of Ascorbic acid
(Vitamin C).
‣ Characterised by Generalised hemorrhagic tendency.
‣ The cells of skeletal system are most often Targets.
“First was discovered in the Pirates & Sailors in 17th Century”

3. WATER SOLUTION VITAMIN
FUNCTIONS OF VITAMIN C
▸ Collagen and Bone formation
▸ Antioxidant & Pro-oxidant Activity
▸ Carbohydrate, Fat & Tyrosine metabolism
▸ Haemopoesis (Iron transport, Maturation of RBC’s)
▸ Conversion of Folic acid into Folinic acid
▸ Synthesis of Steroids
▸ Cellular respiration
▸ Enhances Host Immunity

4. HIGHEST IN ALMA & OTHER CITRUS FRUITS
RECOMMENDED DIETARY INTAKE
▸ Infants :35mg/day
▸ Children :40-45mg/day
▸ Adults :75mg/day

5. BARTONS’S DISEASE - SCURVY CO EXISTING WITH RICKETS
CLINICAL FEATURES
1. Hemorrhagic diathesis
(Skin, Mucous Membrane, Gums, Muscles,
Joints & Sub peritoneum.)
2. Skeletal lesions
(Scorbutic rosary, brittle bones, bow legs etc.)
3. Delayed wound healing
4. Anemia
5. Lesions in Teeth & Gums
6. Skin rash
(Hyperkeratotic & follicular rash)

6. HYPOVITAMINOSIS “C”
▸ Frog posture
(due to Pseudo paralysis)
▸ Scorbutic Rosary
(Beading of Costochondral junction due to separation of epiphysis &
The Junction is angulated due to posterior displacement of sternum)

7. VITAMIN C CONTENT OF THE WBC IS MORE SENSITIVE INDICATOR
INVESTIGATIONS
▸ Reduced Hb
▸ Delayed Clotting time
▸ Fasting Serum Ascorbic acid < 0.1 mg/dl ( N >0.6)
▸ Plasma Ascorbic Acid level < 0.4 mg/dl
▸ Vitamin C Tolerance test - Positive

8. RING SHAPED EPIPHYSIS IN RICKETS / HYPOTHYROIDISM ARE SEEN IN HEALING PHASE
RADIOLOGICAL FINDINGS
▸ Generalised osteoporosis (Ground glass appearance of bone)
▸ Subperiosteal haemorrhage
▸ Wimberger’s Ring Sign (increased zone of calci
fi
cation around epiphysis)
▸ Pencil Point Cortex (Cortical thinning)
▸ White line of Frankel
(dense line b/w Epiphysis & Metaphysis represents calci
fi
ed cartilage in metaphysis)
▸ Trummerfeld’s zone (fragmentation above calci
fi
ed cartilage in metaphysis / White line)
▸ Corner sign of parke
(Subepiphyseal infraction or communication causing mushrooming / cupping of epiphysis)
▸ Pelkan spur (Epiphyseal spur)
▸ Epiphyseal fracture

13. TREATMENT
▸ In Latent Scurvy - Oral / Parenteral
100-200mg/day of Ascorbic acid
▸ In Clinical Scurvy - Loading dose :500 - 1k mg daily for1wk.
Maintenance dose : 50 -75 mg /day

14. TWO RADIOLOGICAL EPONYMS CARRY THE NAME OF
WIMBERGER.
WIMBERGER SIGN - CONG. SYPHILIS
WIMBERGER RING SIGN - SCURVY
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