TRIGGER 14

October 11, 2022

➢ Apal, Grethel Mae
➢ Ballentos, Winkaiser Fradisson
➢ Danila, Kathleen
➢ De Vera, Jhon Michael
➢ Galo, Alliah Yurih
➢ Garcia, Rominna Beatrice
➢ Mansueto, Kyla Camille
➢ Maquiling, Riel Laurence
➢ Otadoy, Rizza Mae
➢ Palacio, Daryl June
➢ Pamakid, Karl Rafael
➢ Tan, Maxene Jhay
➢ Tapayan, Jovial Zenith Ray

College of Radiologic Technology

 Trigger 14

“Fusion”
The patient was a two and a half year-old male at time of presentation
that had been meeting developmental milestones. He had an uneventful
delivery at 34 weeks via C-section due to a breech-presentation. It was
noted that the baby has an abnormally shaped forehead and was
referred by his pediatrician for an emergent pediatric neurosurgical
consultation. At time of admission, a CT scan was obtained and
revealed right frontosphenoid craniosynostosis.
Trigger 14
 Guide Questions:
1. Describe the craniosynostosis in terms of its definition, signs and symptoms, radiographic
appearance, and treatment or intervention.
2. Provide examples for each disease classification of skeletal system disorders. Describe the
pathologic process in terms of its definition, signs and symptoms, radiographic appearance, and
treatment or intervention.
A. Congenital and hereditary disease
B. Inflammatory diseases
C. Vertebral column diseases
D. Neoplastic disease
1. Describe the craniosynostosis in terms of its definition, signs and
symptoms, radiographic appearance, and treatment or intervention.
 Definition

➢ When a newborn is born with craniosynostosis, one or more of the cranial

sutures, which are fibrous connections connecting the bones of the baby's
skull, close early (fuse), before the baby's brain is fully developed. The head
continues to grow in size, looking crooked.

➢ The most common symptom of cranial synostosis is the premature fusion

of a single cranial suture, however it can also include numerous sutures in
the baby's skull (multiple suture craniosynostosis). Rarely, certain
hereditary abnormalities can lead to craniosynostosis (syndromic
craniosynostosis).
 Signs and Symptoms

➢ Usually present at birth, craniosynostosis symptoms intensify in the first

few months of the baby's life. The number of sutures that are fused and the
stage of brain development at which they happen determine the symptoms
and severity. Among the warning signs and symptoms are:

A skull that is malformed, the shape dependent on which sutures are

troubled.
Creation of an abnormally altered skull shape and a high, hard ridge
along the afflicted sutures.
Signs and Symptoms
Radiographic Appearance
 Treatment and Intervention

➢ Surgery is required to release the bones and remodel the skull in order to
treat craniosynostosis. An ear-to-ear incision and the surgical removal,
contouring, and reattachment of the damaged bones have been used to
treat the craniosynostosis. This continues to be the greatest choice on
occasion.
2. Provide examples for each disease classification of skeletal system
disorders. Describe the pathologic process in terms of its definition, signs
and symptoms, radiographic appearance, and treatment or intervention.
A. Congenital and hereditary disease

Achondroplasia
The most common inherited disorder affecting the skeletal system is
achondroplasia, which affects bone in the normal manner, impairing the longitudinal
growth of the bones. Thus, patients with this type of osteochondrodysplasia have a
normal trunk size and shortened extremities.
Signs and Symptoms:
In some instances, ultrasonography may be used for prenatal diagnosis of
achondroplasia. An adult with achondroplasia is usually no more than 4 feet in
height, with lower extremities usually less than half the normal length. Additional
clinical manifestations of this disorder include extreme lumbar spine lordosis,
bowed legs, a bulky forehead with midface hypoplasia, and a narrowing of the
foramen magnum within the skull, which causes neural compression.
Achondroplasia
Radiographic Appearance
 Treatment or Intervention

Orthopedic surgery may be necessary in the

management of complications associated
with achondroplasia. The Ilizarov procedure
has also been used in an attempt to lengthen
the shortened limbs. This procedure was
perfected by Dr. Gavriil Ilizarov. It consists
of a corticotomy of the limb, followed by
attachment of an Ilizarov fixator, which
consists of two circular frames that
surround the limb, wires, and rods. By using
this method, bones may be made to grow at
a rate of approximately 1 mm per day.
B. Inflammatory diseases
Osteomyelitis
➢ Is an inflammation or swelling of bone tissue
that is usually the result of an infection. Bone
infection may occur for many different reasons
and can affect children or adults.
➢ Osteomyelitis can also occur from a nearby
infection due to a traumatic injury, frequent
medication injections, a surgical procedure or
use of a prosthetic device.
➢ The source of the blood infection is usually
Staphylococcus aureus, although it may be
caused by a different type of bacteria or fungal
organism
 Osteomyelitis
Pathology
➢ In most instances, osteomyelitis results from
hematogenous spread, although direct extension
from trauma and/or ulcers
➢ In the initial stages of infection, bacteria multiply,
triggering a localized inflammatory reaction that
results in localized cell death. With time, the
infection becomes demarcated by a rim of
granulation tissue and new bone deposition.
Symptoms:
• Fever • Fatigue
• Swelling, warmth and• Pain in the area of the
redness over the area of infection
the infection
Radiographic Appearance
 Treatment and Intervention

➢ The goal for treatment of osteomyelitis is to cure the infection and minimize any long-
term complications. Treatment may include:
➢ Medications. Administration of intravenous (IV) antibiotics, which may require
hospitalization or may be given on an outpatient schedule. Intravenous or oral antibiotic
treatment for osteomyelitis may be very extensive, lasting for many weeks. It is
important for the patient to continue to take antibiotics for as long as recommended by
the treatment team, even after symptoms of the infection have resolved.
• Monitoring of successive X-rays and blood tests
• Pain management
• Bed rest
• Surgery. In some cases, surgical intervention may be necessary to drain
infectious fluid, or to remove damaged tissue and bone.
C. Vertebral column diseases

➢ The vertebral column, also known as the spinal

column, is the central axis of the skeleton in all
vertebrates. It provides attachments to muscles,
supports the trunk, protects the spinal cord and
nerve roots and serves as a site for hemopoiesis.

➢ The Most Common Spine Conditions:

• Anterospondylolisthesis
• Retrospondylolisthesis
 Anterospondylolisthesis (spondylolisthesis)
Definition:
Anterospondylolisthes is a spinal condition that causes lower back pain. It
occurs when one of your vertebrae, the bones of your spine, slips out of place onto
the vertebra below it.

Signs and Symptoms:

• Spondylosis causes no symptoms. When symptoms do occur, nonsurgical
treatments often are effective. Might also experience:
• Pain and stiffness in the neck
• Tingling, numbness and weakness in the arms, hands, legs or feet
• Lack of coordination and difficulty walking
• Loss of bladder or bowel control
Radiographic Appearance
 Treatment and Intervention

• Bracing to immobilize the spine for a short period (e.g. four months) to allow the pars defect to
heal
• Pain medications and/or anti-inflammatory medication, as needed
• Stretching, beginning with gentle hamstring stretching and progressing with additional
stretches over time
• Exercise that is controlled and builds gradually over time.

➢ Conservative medical management is the preferred choice for treatment before surgical fusion.
• Rest
• chiropractic manipulative therapy
• Surgical intervention - depends on the degree of slippage and is classified as grade I to IV

➢ Grade I being the least severe and grade IV the most severe
 Retrospondylolisthesis
Definition:
Opposite of spondylolisthesis. Retrolisthesis is a posterior or backward
slippage, and spondylolisthesis (sometimes called anterolisthesis) is an
anterior or forward slip.

Signs and Symptoms:

• Uneasiness in one area of your back
• Spine distortion or a bulge in your back
• Limited range of motion
• Back pain
• Other forms of pain in the region of displacement
Radiographic Appearance
 Treatment and Intervention

➢ Surgery is only needed if nonsurgical treatments aren’t effective. Orthopedists and doctor will
see if there will be long-term spinal and neurological damage before recommending surgery.
Nonsurgical treatments involve:
• Hysical therapy to strengthen your spine, back, and core muscles
• Myofascial release, or massages that help restore muscle tone and improve
circulation
• Microcurrent therapy, which uses low-level electric currents to reduce swelling,
inflammation, and pain
• Applying heat compresses for pain
Nutrition
Get enough nutrition so that your body can repair damaged soft tissues. Eat foods that are rich in:
Copper, Calcium, Vitamin D, Manganese, Vitamin A, Vitamin C, Zinc, Proteins and amino acids.
D. Neoplastic disease

Alteration of Cell Growth/ Neoplasia

➢ Neoplasia is the abnormal growth and proliferation of abnormal cells or

abnormal amounts of cells due to a benign or malignant process.
• Neo – New
• Plasia – Growth

➢ Many varieties of bone tumors are seen in patients of all ages; however,
primary bone tumors are more common in children than in adults, and
metastatic bone lesions far outnumber the incidence of primary bone
neoplasms in the adult.
 Characterizations of Benign and Malignant
Characterization of Benign
Benign is a word used to describe tumors that do
not spread to nearby tissues. Being able to permeate the
basal membrane that protects a particular tissue is one
of the most obvious signs that a cell is malignant. Since
they are unable to invade or spread to the surrounding
tissues through the basal membrane, the cells in benign
tumors are not malignant. Therefore, benign tumors are
less concerning and are easily treatable with surgery.
• Slow, Regular growth
• Encapsulated
• Non-Invasive – localized
• Does not metastasize
 The most common benign tumors are:

Osteoma

An osteoma is a less frequent benign growth

most commonly located in the skull. These lesions are
composed of very dense, well-circumscribed, normal
bone tissue that usually projects into the orbits or
paranasal sinuses. They are generally slow-growing
tumors of little significance unless they cause
obstruction, impinge on the brain or eye, or interfere
with the oral cavity. A term associated with osteoma of
the skull is hyperostosis frontalis interna.
 The most common benign tumors are:

Osteochondroma (Exostosis)

The most common benign bone tumor is

osteochondroma, which is three times more common in
men than in women. An osteochondroma arises from
the growth zone between the epiphysis and diaphysis
of long bones, also called metaphysis.
 The most common benign tumors are:

Giant cell tumor

Giant cell tumors (GCTs) are characterized by

the presence of numerous, multinucleated osteoclastic
giant cells. GCTs of the tendon sheath are the second
most common benign soft tissue lesions of the hand and
wrist. Unlike the previously mentioned neoplastic
diseases, GCTs may be either benign or malignant.
Approximately 50% of osteoclastomas are benign, 35%
to 50% recur after surgical excision, and 15% are
aggressively malignant from the beginning.
 Characteristics of Malignant
➢ Malignant is a word used to characterize tumors that have the capacity to
penetrate the basal membrane and infiltrate neighboring tissues. As a result, these
tumors include malignant cells. The lymphatic or circulatory systems are both
used by cancerous cells that have left a malignant tumor to migrate. The name for
this form of spreading to the other tissues of the body is metastasis. Surgery to
remove the malignant cells from the body after metastasis is challenging.
Therefore, to treat them, either chemotherapy or radiation therapy must be used.

• Erratic and uncontrolled growth

• Expansive and Invasive
• Growth via infiltration
• Metastasizes the blood stream and lymphatic channels
 The primary malignant bone tumors are:

Osteosarcoma (Osteogenic Sarcoma)

The cause of osteosarcoma is linked genetically

to deletion of genetic material on chromosome 13 and
the oncogene src. Genetic instability is essential for the
development of sarcomas. Patients with osteosarcoma
frequently lose function of the proteins p53 and RB1,
which are tumor suppressors and protect the genome
from acquiring mutations that may lead to malignancy.
 The primary malignant bone tumors are:
Ewing tumor

This neoplasm occurs at a younger age than any other primary malignant bone
neoplasm, usually between the ages of 5 and 15 years, and rarely after age 30 years. It is also
more common in boys than in girls and shows a predilection for whites, with blacks rarely
affected.
The primary malignant bone tumors are:

Multiple myeloma
Concept Map
 References:

• Craniosynostosis - Symptoms and causes. (2022, September 15). Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/craniosynostosis/symptoms-causes/syc-20354513

• Osteomyelitis. Johns Hopkins Medicine. (2021, August 8). Retrieved October 10, 2022, from
https://www.hopkinsmedicine.org/health/conditions-and-
diseases/osteomyelitis#:~:text=Osteomyelitis%20is%20inflammation%20or%20swelling,can%20happen%20at%20any%
20age.

• Hacking, C. (2022, October 4). Osteomyelitis: Radiology reference article. Radiopaedia Blog RSS. Retrieved October 10, 2022,
from
https://radiopaedia.org/articles/osteomyelitis#:~:text=Plain%20radiograph&text=In%20general%2C%20osteomyeli
tis%20must%20extend,to%2014%20days%20in%20adults.

• Osteomyelitis. LearningRadiology. (n.d.). Retrieved October 10, 2022, from

http://learningradiology.com/notes/bonenotes/osteomyeltispage.htm

• Desimpel, J., Posadzy, M., & Vanhoenacker, F. M. (2017, May 11). Journal of the Belgian Society of Radiology. Retrieved
October 10, 2022, from https://www.jbsr.be/articles/10.5334/jbr-btr.1300/
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