Hypervitaminosis A Lead poisoning Bismuth intoxication Vinyl chloride poisoning Fluorosis Ochronosis

1. TOXIC EFECTS ON SKELETON
SYSTEM
TOXIC EFECTS ON SKELETON
SYSTEM

2. Toxic effects of
Hypervitaminosis A
Lead poisoning
Bismuth intoxication
Vinyl chloride poisoning
Fluorosis
Ochronosis

3. too much vitamin A in the body.
Causes
• Acute -- caused by taking too much vitamin A over a short
period of time
• Chronic -- occurs when too much of the vitamin is present
over a longer period
• One recognized cause is administration from 13-cis
retenoic acid for treatment of cancers such as
neuroblastoma
1.Hypervitaminosis A

4. Imaging findings
• diffuse symmetric periostitis
• may cause premature fusion of ossification centres
• separation of cranial sutures
• Tendenous/ligmentous calcification

5. Increased cortical density more marked in ulna

6. • Main source of lead intoxication is from lead
containing paint and lead containing pipes
• Absorption is greater in children than adults
Pathology
• Lead concentrates in metaphyses of growing
bones
Distal femur
Both ends of tibia
Distal radius
2.Lead poisoning

7. Clinical findings
Musculoskeletal
• Muscle and joint pain
Soft tissue
• Blue-black line in gum margins
• Laboratory findings
• Serum Lead Level >1.2 umol/L
• Urine lead level elevated

8. IMAGING FINDINGS
Bands of increased density at metaphyses of
tubular bones (growing bone)
Bone in bone appearance
Abnormalities in bone modelling
Erlenmeyer flask appearance to distal femur

9. Frontal radiograph of both knees of a child with lead
poisoning show dense metaphyseal bands
involving not only distal femurs and proximal tibias but
proximal fibulas as well

11. A large amount of lead paint chips in the abd &
pelvis of a two year old boy

12. Differential Diagnosis
anaemia - chronic (eg, sickle cell
disease; thalassemia)
chemotherapy - e.g. Methotrexate
growth acceleration lines
treated leukemia

13. Normal variant
 Healing rickets
Trauma: non accidental injury ; stress fracture

14. 3.BISMUTH INTOXICATION
Following treatment for syphilis in the past
A similar appearance to that of lead poisoning

15. Dense metaphyseal lines

16. 4.Vinyl chloride poisoning
Found in workers in PVC manufacture
Causes Raynaud’s phenomenon and a
characteristic acro-osteolysis
Sacroiliitis
Heamangiosarcoma of liver

17. Resorption of central portion of terminal phalanges

18. 5.FLUOROSIS
 Chronic metabolic bone disease
Caused by ingestion of large amounts of fluoride
through either water or food in geographic areas
where high levels offluoride occur naturally.

19. Radiographic features
 Involvement of the axial skeleton is
characteristic, and changes are most marked in
the
• Spine,Pelvis,Ribs
 Plan film
increased bone density - osteosclerosis
osteopaenia / osteoporosis
trabecular blurring or haziness
compact bone thickening

20. periosteal bone formation
ossification of the attachments of tendons,
ligaments, and muscles
interosseous membrane calcification
ossification of the posterior longitudinal ligament
Early fluorosis
 bone deposition and thickening at the junctions
of trabeculae.
sandlike, granular, or particle like bone structure
on radiographs.

21. Advanced fluorosis
 trabeculae are more generally thickened because
of new bone formation on the trabecular surface.
 If the trabeculae are fused, focal round densities
are seen in the medullary bone.
Osteopenia (less common) also may occur in
fluorosis - especially in younger patients at an
earlier stage
Calcification of the sacrotuberous ligament is
considered a characteristic feature.

22. increased bone density Loss of cortico medullary diff

23. Increased bone density of the visualized bones

25. Differential Diagnosis
Haematological causes
myelofibrosis
sickle cell disease
Metabolic bone disorders
hyperthyroidism
hypoparathyroidism

26. Congenital
sclerosing bony dysplasias, e.g.:
osteopetrosis
Pyknodysostosis
Malignancy
leukaemia

27. 6.Ochronosis
Autosomal recessive metabolic disorder.
Caused by lack of homogentisic acid
oxalate,which accumulates in the connective
tissue.

28. Clinical presentation
 Pigmentation of auricular cartilages and sclera
Dark urine

29. Radiographic Features
Plain film
Vertebral:
• multi level disc space narrowing
• intervertebral disc calcification
• Kyphoscoliosis

30. Joints
symmetrical or assymetrical joint space loss
sub-chondral sclerosis
chondrocalcinosis

31. Interverteberal disc calcification and scoliosis

32. Gross joint space narrowing of sacroiliac joint and
intervertebral disc space narrowing and calcification

33. THANKS