Leukaemia

Leukaemia.
Leukaemia is a process involving the uncontrolled proliferation of the blood forming cells. The name of the particular leukaemia comes from the type of white cells that proliferate. Theories of its generation involve the idea of delayed maturation. That is if an ancestor cell in the bone marrow goes thorugh a few more cell divisions before forming the recognisable precursor adult cell then the number of those cells will increase. Research into the multiple factors in cell genetics is proceeding so fast that it is more appropriate to recommend the nearest search engine to enquiring minds.
The visible evidence of Leukamia usually follows an aggressive or a long standing abnormality. The radiologic expression of the disease is of an enlargement of the soft tissue mass of the bone marrow with loss of bone, particularly at the metaphyses where bone turnover is a little higher. The bone cortex amy also be eroded from below, giving a scalloped appearance. There may be other clues, such as splenic anlargement, visible on a radiograph of the pelvis. Lytic areas, chloromas, are rare, but are due to local masses of leukaemic cells.
The stem cell theory suggests that some cases of myelofibrosis might be included in this document, but the condition is commoner in polycythaemia.

Figure 1:This view is taken from an intravenous urogram. It shows a large, bounded, soft tissue density in the left hypochondrium which extends down to the left iliac crest. The density in the right hypochrondium, the liver density, also extends lower than is usual. Both kidneys are also lower in the abdomen than is usual, but appear grossly normal. There is no change in the visible bone structure and the patient has not lived abroad.
D=leukaemia with splenomegally

Figure 2:Clinical presentation:55 year old man with acute myloid leukaemia and recent neck pain.
The neck is flexed in both views. The first view shows some increase in the thickness of the anterior paravertebral soft tissue in a patient who isn't swallowing. There is some bone-destruction of the anterior inferior margin of the 5th cervical vertebra, indicated by the absence of a similar osteophyte to that of the upper margin of the 6th cervical vertebra.
The later view shows local angulation of the cervical spine, secondary to further bone destruction in C5 and loss of the C5/C6 disc-space. The anterior soft tissue swelling is increased.
D=Pyogenic discitis&osteomyelitis

Figure 3:Clinical presentation:Adult male with anaemia.
The particular feature is the low density of pubis and sacrum with relative sparing of ilia and femora. Patchy bone loss can be seen in both ischia and the proximal metaphyses of both femora, coarsening the visible bone architecture. There is a fairly well-defined area of patchy bone loss in the upper part of each pubic bone centred around the mid-line. Some cortical scalloping of the cortex of pubic bones is present. The density of the ilia is probably normal, except adjacent to the sacro-iliac joint margins where some more extensive destruction is seen on the right side. The density of Sacrum and vertebrae is reduced by what appears to be a patchy destructive process.
The appearance is of a patchy lytic bone process that is predominatly mid-line. This might suggest a process that affects active bone marrow, which is often restricted in the adult to the axial skeleton and the medulla of adjacent parts of long bones.
D=lk inf

Figure 4:Clinical presentation:A 13 year old boy with anaemia.
There is a patchy destructive process, prodominantly in the medulla of the distal metaphyses of the left radius and ulna. The process is more marked in the distal metaphysis of the left ulna. More proximally, there is a visible reaction over the diaphyses The bone cortex is elevated and thickened. This takes the form of a thick line, separated from the cortex of the diaphysis of the right radius. A similar appearance is seen over the distal metaphyses of both humeri.
D=lk infitration

Figure 5:Clinical presentation:A 45 year old man with anaemia.
There is a patchy destructive process, prodominantly in the medulla of the distal metaphysis of the right humerus. The process undermines and thins the cortex
D=lk infiltration