link
Bookmarks
Normal Musculoskeletal Developmental Variants Confused With Disease
A. Carlson Merrow, Jr., MD, FAAP
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Subscribe
0
1
0
0

KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Skeletally immature patients have numerous radiolucent growth centers composed of cartilage
              • Primary physis: Site of majority of longitudinal growth; lies between epiphysis & metaphysis
              • Secondary physis: Surrounds secondary ossification center (SOC) in epiphysis or equivalent bone
                • Interface where cartilaginous precursor is transformed into bone from central to peripheral
                • Process is uniform in some centers (capitellum, femoral head), nonuniform in others (fragmented trochlea, irregular medial femoral condyle)
              • Apophysis: Nonarticular SOC with muscle/tendon attachment (ischial & tibial tuberosities)
              • Zone of provisional calcification (ZPC): Thin, radiodense line at interface of physeal growth cartilage & newly mineralized bone
            • Accessory ossification centers: Separate small rounded ossicles vs. SOCs in same unossified cartilage as adjacent epiphysis (or equivalent bone)
            • Pseudoepiphysis: False appearance of growth centers at distal 1st & proximal 2nd-5th metatarsals & metacarpals
            • Physiologic periosteal reaction (PPR): Smooth, solid, new bone being symmetrically & rapidly laid down along entire lengths of long bone diaphyses in infants

          IMAGING

          • General Features

            • Radiographic Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      DIAGNOSTIC CHECKLIST

                      • Image Interpretation Pearls

                        Selected References

                        1. Kan JH et al: Embryology, anatomy, and normal findings. In: Caffey's Pediatric Diagnostic Imaging, 13th ed. Philadelphia: Elsevier Saunders. 1219-36, 2019
                        2. Lerisson H et al: Radiographic/MR imaging correlation of the pediatric knee growth. Magn Reson Imaging Clin N Am. 27(4):737-51, 2019
                        3. Maloney E et al: The pediatric patella: normal development, anatomical variants and malformations, stability, imaging, and injury patterns. Semin Musculoskelet Radiol. 22(1):81-94, 2018
                        4. Woo TD et al: Radiographic morphology of normal ring apophyses in the immature cervical spine. Skeletal Radiol. 47(9):1221-8, 2018
                        5. Adib O et al: Pediatric cervical spine in emergency: radiographic features of normal anatomy, variants and pitfalls. Skeletal Radiol. 45(12):1607-17, 2016
                        6. Berko NS et al: Imaging appearances of musculoskeletal developmental variants in the pediatric population. Curr Probl Diagn Radiol. 44(1):88-104, 2015
                        7. Idriz S et al: CT of normal developmental and variant anatomy of the pediatric skull: distinguishing trauma from normality. Radiographics. 35(5):1585-601, 2015
                        8. Jaremko JL et al: Common normal variants of pediatric vertebral development that mimic fractures: a pictorial review from a national longitudinal bone health study. Pediatr Radiol. 45(4):593-605, 2015
                        9. Oestreich AE: Concave distal end of ulna metaphysis alone is not a sign of rickets. Pediatr Radiol. 45(7):998-1000, 2015
                        10. Zbojniewicz AM et al: Imaging of osteochondritis dissecans. Clin Sports Med. 33(2):221-50, 2014
                        11. Laor T et al: Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? AJR Am J Roentgenol. 199(5):1121-8, 2012
                        12. Varich LJ et al: Normal maturation of the distal femoral epiphyseal cartilage: age-related changes at MR imaging. Radiology. 214(3):705-9, 2000
                        13. Laor T et al: Musculoskeletal system. In Kirks DR: Practical Pediatric Imaging: Diagnostic Radiology of Infants and Children. 3rd ed. Philadelphia: Lippincott-Raven. 327-510, 1998
                        Related Anatomy
                        Loading...
                        Related Differential Diagnoses
                        Loading...
                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Imaging

                          • Top Differential Diagnoses

                            • Clinical Issues

                              • Diagnostic Checklist

                                TERMINOLOGY

                                • Definitions

                                  • Skeletally immature patients have numerous radiolucent growth centers composed of cartilage
                                    • Primary physis: Site of majority of longitudinal growth; lies between epiphysis & metaphysis
                                    • Secondary physis: Surrounds secondary ossification center (SOC) in epiphysis or equivalent bone
                                      • Interface where cartilaginous precursor is transformed into bone from central to peripheral
                                      • Process is uniform in some centers (capitellum, femoral head), nonuniform in others (fragmented trochlea, irregular medial femoral condyle)
                                    • Apophysis: Nonarticular SOC with muscle/tendon attachment (ischial & tibial tuberosities)
                                    • Zone of provisional calcification (ZPC): Thin, radiodense line at interface of physeal growth cartilage & newly mineralized bone
                                  • Accessory ossification centers: Separate small rounded ossicles vs. SOCs in same unossified cartilage as adjacent epiphysis (or equivalent bone)
                                  • Pseudoepiphysis: False appearance of growth centers at distal 1st & proximal 2nd-5th metatarsals & metacarpals
                                  • Physiologic periosteal reaction (PPR): Smooth, solid, new bone being symmetrically & rapidly laid down along entire lengths of long bone diaphyses in infants

                                IMAGING

                                • General Features

                                  • Radiographic Findings

                                    • MR Findings

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          CLINICAL ISSUES

                                          • Presentation

                                            DIAGNOSTIC CHECKLIST

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Kan JH et al: Embryology, anatomy, and normal findings. In: Caffey's Pediatric Diagnostic Imaging, 13th ed. Philadelphia: Elsevier Saunders. 1219-36, 2019
                                              2. Lerisson H et al: Radiographic/MR imaging correlation of the pediatric knee growth. Magn Reson Imaging Clin N Am. 27(4):737-51, 2019
                                              3. Maloney E et al: The pediatric patella: normal development, anatomical variants and malformations, stability, imaging, and injury patterns. Semin Musculoskelet Radiol. 22(1):81-94, 2018
                                              4. Woo TD et al: Radiographic morphology of normal ring apophyses in the immature cervical spine. Skeletal Radiol. 47(9):1221-8, 2018
                                              5. Adib O et al: Pediatric cervical spine in emergency: radiographic features of normal anatomy, variants and pitfalls. Skeletal Radiol. 45(12):1607-17, 2016
                                              6. Berko NS et al: Imaging appearances of musculoskeletal developmental variants in the pediatric population. Curr Probl Diagn Radiol. 44(1):88-104, 2015
                                              7. Idriz S et al: CT of normal developmental and variant anatomy of the pediatric skull: distinguishing trauma from normality. Radiographics. 35(5):1585-601, 2015
                                              8. Jaremko JL et al: Common normal variants of pediatric vertebral development that mimic fractures: a pictorial review from a national longitudinal bone health study. Pediatr Radiol. 45(4):593-605, 2015
                                              9. Oestreich AE: Concave distal end of ulna metaphysis alone is not a sign of rickets. Pediatr Radiol. 45(7):998-1000, 2015
                                              10. Zbojniewicz AM et al: Imaging of osteochondritis dissecans. Clin Sports Med. 33(2):221-50, 2014
                                              11. Laor T et al: Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? AJR Am J Roentgenol. 199(5):1121-8, 2012
                                              12. Varich LJ et al: Normal maturation of the distal femoral epiphyseal cartilage: age-related changes at MR imaging. Radiology. 214(3):705-9, 2000
                                              13. Laor T et al: Musculoskeletal system. In Kirks DR: Practical Pediatric Imaging: Diagnostic Radiology of Infants and Children. 3rd ed. Philadelphia: Lippincott-Raven. 327-510, 1998