Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Case 82 Clubfoot
- Case 83 Developmental dysplasia of the hip
- Case 84 Legg–Calve–Perthes disease
- Case 85 Slipped capital femoral epiphysis
- Case 86 Langerhans cell histiocytosis: MRI/PET for diagnosis and treatment monitoring
- Case 87 Congenital syphilis
- Case 88 Medial malleolus avulsion fracture
- Case 89 Triplane fracture
- Case 90 Fibrous dysplasia
- Case 91 Chest wall sarcoma
- Case 92 Campomelic dysplasia
- Case 93 Type II collagenopathy (hypochondrogenesis)
- Case 94 Morel-Lavallée lesions
- Case 95 Infantile myofibromatosis
- Case 96 Osteochondritis dissecans of the capitellum
- Index
- References
Case 87 - Congenital syphilis
from Section 9 - Musculoskeletal imaging
Published online by Cambridge University Press: 05 June 2014
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Case 82 Clubfoot
- Case 83 Developmental dysplasia of the hip
- Case 84 Legg–Calve–Perthes disease
- Case 85 Slipped capital femoral epiphysis
- Case 86 Langerhans cell histiocytosis: MRI/PET for diagnosis and treatment monitoring
- Case 87 Congenital syphilis
- Case 88 Medial malleolus avulsion fracture
- Case 89 Triplane fracture
- Case 90 Fibrous dysplasia
- Case 91 Chest wall sarcoma
- Case 92 Campomelic dysplasia
- Case 93 Type II collagenopathy (hypochondrogenesis)
- Case 94 Morel-Lavallée lesions
- Case 95 Infantile myofibromatosis
- Case 96 Osteochondritis dissecans of the capitellum
- Index
- References
Summary
Imaging description
AP and lateral radiographs of the right lower extremity in a young infant demonstrated diffuse exuberant periosteal reaction, diaphyseal sclerosis, and metaphyseal irregularity with horizontal metaphyseal lucent lines (Fig. 87.1a,b), suggestive of bony changes of congenital syphilis. AP radiograph of the bilateral lower extremities in a different infant with congenital syphilis demonstrated irregular, focal lucencies of the medial proximal metaphyses of the bilateral tibiae, the Wimberger sign (Fig. 87.2). AP radiographs of bilateral upper extremities in another infant demonstrated metaphyseal lucencies and diaphyseal sclerosis (Fig. 87.3).
Importance
Congenital syphilis is transferred through the placenta in the second or third trimester in mothers with untreated or recently treated primary or secondary syphilis. The pathogenesis of this disease is transplacental migration of Treponema pallidum bacteria. Bony changes are thought to result mostly from trophic effects rather than direct osteomyelitis. There is inhibition of osteogenesis and disturbance of active endochondral ossification. Symmetric involvement of the sites of endochondral ossification leads to bony changes at the epiphyseal-metaphyseal junctions, costochondral junctions, and endochondral ossification sites in the sternum and spine. A baby born to a mother with untreated syphilis in the primary or secondary stage has a nearly 100% chance of acquiring the infection. Radiographic changes occur approximately six to eight weeks after initial infection, so that they may not be present at birth but only manifest subsequently. Direct clinical examination, treponemal tests, VDRL (venereal disease research laboratory [test for syphilis]), and rapid plasma reagin are used to confirm the diagnosis. Results are considered conclusive when the infant’s titer is at least four times higher than that of the mother.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Pediatric ImagingVariants and Other Difficult Diagnoses, pp. 354 - 358Publisher: Cambridge University PressPrint publication year: 2014