Definition, functions, RDA, clinical features, radiological findings, treatment.

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
THANK “U” for Listening :)