Salt and Pepper pot appearance of skull is seen in
(A) HyperparathyroidismHYPERPARATHYROIDISM:Uncontrolled production of parathyroid hormone causes | bone mass secondary to | number of osteoclasts, | osteoid volume (defect in mineralization), slightly | number of osteoblasts.Loss of lamina dura of tooth, Pepper pot appearance in skull, "Rotting fence post' appearance of proximal femur in childrenBone Resorption: Subperiosteal (most constant & specific finding; virtually Pathognomonic of Hyperparathyroidism).Lacelike irregularity of cortical margin; may progress to scalloping/spiculation (pseudoperiostitis), involves phalangeal tufts (earliest involvement), radial aspect of middle phalanx of 2nd & 3rd finger beginning in proximal metaphyseal region (early involvement)Subchondral collapse of cortical bone & overlying cartilage with development of erosion, cyst, joint narrowing.Cortical resorption, trabecular resorption, subligamentous bone resorption.Bone Softening: Basilar impression of skull, Wedged vertebrae, kyphoscoliosis, biconcave vertebral deformities, bowing of long bones, Slipped capital femoral epiphysis.Brown Tumor: Eccentric, cortical frequently solitary expansile lytic wellmarginated cystlike lesion, endosteal scalloping, seen in jaw, pelvis, rib, metaphyses of long bones (femur), facial bones, axial skeleton (DDx--GCT).Osteosclerosis - 'Rugger jersey spine' - sclerosis of vertebral endplates with intervening normal osseous densitySoft-Tissue Calcification: Metastatic calcification cornea, viscera (lung, stomach, kidney), periarticular in hip, knee, shoulder, wrist & chondrocalcinosis in menisci, wrist, shoulder, hip, elbow.Erosive Arthropathy, Periosteal New-Bone Formation.Sequele Hyperparathyroidism 1. Renal stones & nephrocalcinosis 2. osteoblastic activity--osteitis fibrosa Cystica, brown tumours (primary Hyperparathyroidism) bone softening (fractures), 3. Peptic ulcer disease, 4. Calcific pancreatitis, 5. Soft-tissue calcifications (Secondary Hyperparathyroidism).Primary Hyperparathyroidism: Hypercalcemia due to uncontrolled secretion of parathormone by one or more hyperfunctioning parathyroid glands featuring brown tumor & chondrocalcinosisSecondary Hyperparathyroidism: Diffuse adenomatous hyperplasia of all four parathyroid glands as a compensatory mechanism in any state of hypocalcemia featuring soft-tissue calcifications & osteosclerosis.Tertiary Hyperparathyroidism: Development of autonomous PTH adenoma in patients with chronically overstimulated hyperplastic parathyroid glands (renal insufficiency).Pseudo hyperparathyroidism: Ectopic parathormone production in paraneoplastic syndrome in bronchogenic carcinoma and renal cell carcinoma.CHARACTERISTIC X-RAY APPEARANCES'Sun-ray1 appearance... Osteogenic sarcoma'Soap bubble' appearance... Osteoclastoma'Moth-eaten' appearance around epiphysis... Rickets'Rain drop' osteolytic lesions in skull ... Letterer-Siwe disease, Multiple myeloma'Saw tooth' appearance of metaphysis... Congenital syphilis'Cup and Pencil' joint appearance ... Rheumatoid arthritis'Ground glass' appearance... Fibrous dysplasia'Honeycomb' appearance ... Chronic osteomyelitis, Paget's disease, Osteoclastoma, Adamantinoma'Cricket bat* shaped ribs... Morquio disease'Ribbon ribs'... Neurofibromatosis'Shepperd crook' deformity of femur... Fibrous dysplasia'Flask shaped' femur... Thalassemia'Bag of bones' appearance... Charcot's joints'Moth eaten' appearance of skull... Pyogenic osteomyelitis'Onion peel' appearance... Ewing's sarcoma'Bossing' of calvarium & 'Cupping' of distal... Rickets end of radius & ulna'Bone within a bone' appearance ... Osteopetrosis, Periostitis, Scurvy, Gaucher's disease & congenital syphilis'Swiss cheese' appearance... Plasmacytoma'Floating teeth' appearance... Histiocytosis'Celery stick' of long bones in infants... Congenital rubellaBilateral iliac horns ... Nephrotic syndrome'Pencil in cup' appearance... Arthritis mutilans type of Psoriatic arthritis'Trident hand' is seen in... Achondroplasia'Spina ventosa' (air within a small bone)... Tuberculous dactylitis'Sabre tibia'... Congenital syphilis'Hot cross bun' appearance of skull... Congenital syphilis'Bucket handle' Epiphyseal cartilage... Battered Baby'Lace-work' periostitis... Tertiary syphilis'Bayonet-like' wrist... Madelung's deformity'Candle wax' appearance... Meliorheostosis'Marble bone'... Osteopetrosis'Wormian bones'... Fibrous dysplasiaBanana fracture... Paget's diseaseEnlarged sclerotic ivory vertebra ... Paget's diseaseIvory dense vertebra ... Hodgkin's lymphoma'Cod-fish' vertebra... Hyperparathyroidism, Osteomalacia'Spoke wheel' calcification within osteolytic ... Haemangioma lesion of bone'Squaring' of vertebral bodies ... Ankylosing spondylitis'Bamboo-spine' appearance... Ankylosing spondylitis'Hair brush' appearance of skull... Hyperparathyroidism'Geographical' appearance of skull... Hand-Schuller Christian
Hyperparathyroidism
Paget's Disease
Multiple Myloma
Pseudo hyperparathyroidism
Skeletal System