Periosteal Lesions

Periosteal Lesions
Dr KE Polden
Livingstone Hospital


2

,Periosteum
• Thin layer surrounding all bone

• Not joints of Long Bones

• Consist of two layers
 Fibrous layer (Fibroblasts)
 Cambium Layer (Progenitor cells  Osteoblasts)


• Nociceptive nerve endings. (Very sensitive to manipulation)

,Periosteal Reaction
• Definition
 Non-specific reaction – Due to Irritation of Periosteum.
 Malignant tumour
 Benign tumour
 Infection
 Trauma




• Two Patterns of reaction
 Benign (Benign tumours and trauma)
 Aggressive (Malignant tumours, benign lesions with aggressive behaviour – Infx)

,Benign Periosteal Reactions
• Malignant lesions NEVER cause a benign periosteal reaction!!!

• Thick, wavy & uniform callus formation (Chronic Irritation)

• Periosteum has time to lay down thick new bone – Normal appearance

,Aggressive Periosteal Reactions
• Periosteum has no time to consolidate (Rapid turnover)

• Multilayered, lamellated or bone formation perpendicular to the cortical bone.

• Spiculated and Interrupted

• Codman’s Triangle

, Osteosarcoma Ewing sarcoma Infection




Interrupted periosteal reaction Lamellated reaction Multilayered Periosteal Reaction
Codman’s Focally Interrupted
Triangle Reaction

,
, Differential Diagnosis
• Battered baby Syndrome

• Stress Fractures

• Scurvy

• Tuberculosis

• Congenital/juvenile Syphilis

• Fungal Osteomyelitis

• Typhoid Osteomyelitis