核磁共振成像辅助诊断缺乏典型临床和影像学征兆的坏血病

H. Manek, Foram Gala
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摘要

坏血病是一种维生素 C 缺乏症,会导致胶原蛋白、类骨和牙本质合成障碍,分别引起皮肤、牙齿和骨骼表现。坏血病的影像学特征已经非常明确,但随着磁共振成像(MRI)在肢体病变中的应用日益广泛,放射科医生有必要了解其常见和不典型的磁共振成像结果。本研究纳入了两名出现大腿疼痛和肿胀并被证实患有坏血病的儿童。第一名患儿患有脑瘫,由于放射线检查怀疑其趾骨脱位,因此对其进行了磁共振成像检查。核磁共振成像证实股骨远端趾骨分离,骨膜下聚集。第二名患者发育正常,大腿肿胀无外伤性疼痛。X光片显示股骨远端干骺端和二骺端交界处骨折。两名患者的核磁共振成像均显示骨膜下聚集和周围肌肉水肿,并伴有异质骨髓信号。炎症指标正常。补充维生素 C 治疗后的随访X光片显示骨膜下血肿骨化,症状缓解。这两个病例凸显了核磁共振成像在诊断非典型坏血病病例中的重要作用,而非典型坏血病病例对维生素 C 补充剂的反应非常好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
MRI as an aid to diagnosis of scurvy in absence of classic clinical and radiographic signs
Scurvy, a Vitamin C deficiency disorder leads to impaired synthesis of collagen, osteoid, and dentine, causing cutaneous, dental, and skeletal manifestations, respectively. The radiographic features of scurvy are very well established but the increasing use of magnetic resonance imaging (MRI) in limb pathologies warrants radiologists to be aware of its common as well as atypical magnetic resonance findings. Two children who presented with pain and swelling of the thigh and were proven to have scurvy were included in the study. The first child had cerebral palsy and MRI was performed as radiographs were suspicious for physeal subluxation. MRI confirmed physeal separation of the distal femur with subperiosteal collection. The second patient was developmentally normal and had non-traumatic painful thigh swelling. Radiographs showed a fracture at the distal metaphyseal–diaphyseal junction of the femur. Subperiosteal collection and surrounding muscle edema with heterogenous marrow signal were seen in both the patients on MRI. Inflammatory markers were normal. Follow-up with radiographs after treatment with vitamin C supplementation showed ossification of the subperiosteal hematomas and resolution of the symptoms. These two cases highlight the significance of MRI in reaching a diagnosis in atypical cases of scurvy which has excellent response to Vitamin C supplementation.
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