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Age / Sex : 35 / M
Age/Sex: 35/M
C.C.: CA 38-year old female was transferred from local clinics due to chest abnormality on simple radiography.
1) What is your impression?
Courtesy : Kyung Jin Suh, MD., Dankook University Hospital
Diagnosis: cretinism
Discussion
Findings:
- Chest PA and lateral view showed superior mediastinal widening and presenile dense astherosclerotic vascular calcifications in the thoracoabdominal aorta.
- Vertebral bodies of T-L spine showed bullet shaped vertebra with persistent canals of Hahn (nutrient foramen) and wide disc space. Multifocal nephrocalcinosis were noted (arrow).
- Pelvic bone showed unfused and poorly ossified apophysis. Both femoral head showed epiphyseal dysgenesis and delayed union.
- Chest CT showed mediastinal lipomatosis and astherosclerotic vascular calcifications. Delayed and dysgenetic epiphysis of shoulder and spine. Non-visualization of normal thyroid gland in situ.
Diagnosis: Adult cretinism (Hypothyroidism with ectopic thyroid) Differential Diagnosis;
Discussion:
A fundamental radiographic feature of hypothyroidism of infants, children, and young adults is retardation of skeletal maturation. In adult-onset hypothyroidism, bone abnormalities are mild. Altered kinetics in bone indicate a consistent reduction in the exchangeable pool of calcium and its rate of turnover and a decrease in the rates of bone formation and resroption. In this neglected hypothyroidism of 38-year old female mental retardation and marked skeletal manifestations are manifestated. Developmental abnormalities with marked delayed and abnormal epiphyseal maturation with fragmented irregular epiphyseal contours and delayed dental development were confirmed by radiographic findings. Also in hypothyroidism, abnormal calcium mentabolism and excretion resulted in abnormal calcific deposition, nephrocalcinosis and dystrophic calcification in various organs and soft tissues, well documented in parotid calcification and premature astherosclerosis. Serologic examination confirmed the thyroxine and triiodothyronine deficiency. Thyroid scan showed the ectopic lingual thyroid and absent normal thyroid tissue in situ.
References
1. Borg SA, Fitzer PM, Young LW. Roentgenologic Aspects of Adult Cretinism: Two Case Reports and Review of the Literature. AJR 1975; 123:820 - 828.
2. Resnick D. Diagnosis of bone and joint disorders, 4th ed. Philadelphia: Saunders, 2002;2026-2041.
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