Thursday, May 31, 2012

Stippled Epiphyses Differential Diagnosis

Today's Daily Diff is about stippled epiphyses. In these cases, the epiphyses appear to have multiple, small, round densities within them. If you have a hard time remembering the diverse causes, don't worry - just take a WHACK at it:

DiseaseNotes
WWarfarin
  • maternal use during pregnancy
HHypothyroidism
Hans Zellweger syndrome

  • Hypothyroidism / cretinism is a much more common cause
  • Hans Zellweger aka cerebro-hepato-renal syndrome
  • rare leukodystrophy
  • punctata in patella
AAlcohol 
  • maternal use during pregnancy
CChondrodysplasia punctata congenita
  • multiple variants exist (ex: Conradi–H√ľnermann syndrome)
  • causes growth problems
Kvitamin K deficiencies
  • Vitamin K reductase deficiency
  • ex: Warfarin use

Admittedly, the mnemonic is a bit of a stretch, but essentially the diagnoses are either due to syndromes or factors that affect vitamin K metabolism.

Stippled epiphyses
Source: Roentgen Ray Reader