MR imaging in a child with scurvy: a case report

Abstract

Scurvy is very rare disease in industrialized societies. Nevertheless, it still exists in higher risk groups including economically disadvantaged populations with poor nutrition, such as the elderly and chronic alcoholics. The incidence of scurvy in the pediatric population is very low. This study reports a case of scurvy in a 5-year-old girl with cerebral palsy and developmental delay based on MRI findings.

Fig. 1

A. Anteroposterior radiograph of both knees shows a thick sclerotic metaphyseal line (thin black arrows) above a widened physis and small beaklike excrescences (white arrows) at the metaphysis in both femora. Soft tissue bulging is noted (thick black arrow). B.Lateral radiograph of the left knee shows a disruption of the alignment of the distal femoral physis (arrow).

Fig. 2

MRI of the left thigh performed at the first hospital day. A. Coronal T2-weighted image shows a diffuse bone marrow signal change (black arrows) of the femur shaft with a large amount of subperiosteal fluid collection (arrowhead) and displacement of the distal epiphysis (white arrow). B.Axial T2-weighted image shows a fluid-fluid level in the subperiosteal fluid collection (black arrow). The surrounding vastus and hamstring muscles also show high intensity signal lesions (white arrows).

Fig. 3

Follow up MR images of both thighs. A. A coronal T2-weighted image shows a larger subperiosteal hematoma at the left femur and a new subperiosteal hematoma (arrows) with signal change of bone marrow of the right femur. B.A coronal contrast enhanced fat suppression T1-weighted image shows moderate enhancement of the periosteum and adjacent soft tissue (white arrows).

Fig. 4

The radiograph performed six weeks after vitamin C supplementation. Large shells of periosteal bone (arrows) are present at the left femur. There was improvement of the metaphyseal sclerotic line and widened physis compared to the initial radiograph.