Long bones manifestations of congenital syphilis

Poster No.: C-0139

Congress: ECR 2011
Type: Educational Exhibit
Authors: 1 1 1
T. F. de Souza , P. P. Collier , E. J. M. Bronzatto , G. L. P.
2 1 1 2
Martins , E. M. D. B. Pacheco ; Campinas/BR, Campinas, Sa/
BR
Keywords: Musculoskeletal bone, Pediatric, Education, Plain radiographic
studies, Infection, Parasites
DOI: 10.1594/ecr2011/C-0139

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Learning objectives

To analyze the osseous manifestations of the Congenital Syphilis in long bones.

To reinstate the congenital osseous manifestations as an important element in the

differential diagnosis of the disease in infancy.

To call attention to the radiological changes to the new generation of radiologists who
underwent their training at the time when the disease was a rarity.

Background

Congenital syphilis is a re-emergent medical problem and radiology plays an important

1
role in the early diagnosis .

2
The common findings are metaphysitis, periostitis and osteitis of the long bones .

Transverse metaphyseal lucencies occur early in the disease, and with Wimberger's sign
3
they are the prime evidence of pathology in syphilitic bone .

3
Other radiographic changes are probably owing to minimal trauma .

Reviews of radiographs in 22 patients with skeletal lesions ascribed to congenital lues

from our didactic archive were analyzed.

Imaging findings OR Procedure details

Metaphyseal Abnormalities:

1. Nonspecific trophic lucent bands

2. Alternating bands

3. Focal fragmentation and destruction

Wimberger corner sign

Pathologic fractures and callus

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Periosteal reaction

Diaphysis abnormalities

Images for this section:

Fig. 1: Lucent bands in proximal and distal extremity of humerus, radius and ulna

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Fig. 2: Lucent bands in proximal and distal extremity of femur, tibia and fibula

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Fig. 3: Examples of lucent bands in distal extremity of radius and ulna

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Fig. 4: Other examples of lucent bands in distal extremity of radius and ulna

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Fig. 5: Alternating dense and lucent bands in distal femur, and proximal tibia and fibula

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Fig. 6: Alternating dense and lucent bands in distal humerus, radius and ulna, and
proximal radius

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Fig. 7: Focal fragmentation and Destruction in distal left femur

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Fig. 8: Other example of focal lesion in distal femur

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Fig. 9: Focal lesion in proximal humerus

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Fig. 10: Wimberger Sign: Metaphyseal destruction in the upper medial tibia, usually
sparing the most recently formed few millimeters of metaphysis

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Fig. 11: Wimberger Sign

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Fig. 12: Wimberger Sign

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Fig. 13: Pathologic fracture in ulna, with pseudoartrosis and focal destruction in distal
humerus

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Fig. 14: Patient with bilateral callus after pathologic fracture in proximal femur

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Fig. 15: Same patient in a closer view

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Fig. 16: Callus in distal femur with diffuse metaphyseal abnormalities

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Fig. 17: Callus, periosteal reaction and metaphyseal abnormalities

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Fig. 18: Periosteal reaction

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Fig. 19: Periosteal reaction

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Fig. 20: Periosteal reaction

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Fig. 21: Periosteal reaction

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Fig. 22: Patient with diaphysis lucent lesions, metaphysis abnormalities and periostitis

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Fig. 23: Another patient with diaphysis lucent lesions, metaphysis abnormalities and
periostitis

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Fig. 24: Diffuse osteitis and metaphysitis in long bones in right upper limb

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Fig. 25: Diffuse osteitis and metaphysitis in long bones in same patient left upper limb

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Fig. 26: Diffuse osteitis and metaphysitis in long bones in same patient right lower limb

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Fig. 27: Diffuse osteitis and metaphysitis in long bones in same patient left lower limb

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Conclusion

Congenital syphilis should be considered in a newborn infant with these radiographic

manifestations, especially when a suggestive history is obtained.

Personal Information

References

1 - Centers for Disease Control and Prevention. [Congenital Syphilis - United States,
2003-2008]. MMWR 2010; 59: 413-7.

2 - Sachdev M, Bery K, Chawla S. [Osseous manifestations in congenital syphilis: a study

of 55 cases]. Clin Radiol 1982; 33(3): 319-23.

3 - Rosen EU, Solomon A. [Bone lesions in early congenital syphilis]. S Afr Med J 1976;
50(5): 135-8.

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