What causes the Wimberger sign on radiography of the knee?
Let me know in the comments.
Click to reveal the answer
Answer:
The Wimberger sign is focal, symmetrical destruction of the medial aspect of the proximal tibial metaphyses bilaterally, and is highly suggestive of congenital syphilis. It is one component of a wider skeletal picture that appears within the first weeks to two years of life. The most specific accompanying finding is diaphyseal periostitis, typically symmetrical and multilayered along the long bones. Metaphyseal changes include alternating lucent and dense transverse bands giving a sandwich or celery-stalk appearance, and the Wegner sign, a serrated saw-tooth irregularity of the metaphysis. Involvement is characteristically bilateral and symmetrical, which is the feature that separates it from the asymmetric destruction of osteomyelitis, and it should also be distinguished from non-accidental injury, rickets and metastatic neuroblastoma. It must not be confused with the Wimberger ring sign of scurvy, which is a sclerotic rim around a lucent epiphysis and a different entity entirely.
Why is it called so?
It is named for Hans Wimberger, who described the metaphyseal destruction of congenital syphilis.
Pathophysiology
Treponema pallidum reaching the fetus haematogenously seeds the metaphyses, where the sluggish blood flow of the terminal capillary loops at the zone of provisional calcification favours settlement. The resulting syphilitic granulation tissue and osteochondritis destroy bone at these sites. The medial proximal tibial metaphysis is affected preferentially because it is among the most rapidly growing and best perfused metaphyses in the infant skeleton. Because the organism is disseminated by the bloodstream to all such sites simultaneously, the lesions are bilateral and symmetrical, which is the diagnostic hallmark.
Alternative names: Wimberger’s sign of congenital syphilis
Other associated named signs: Wegner sign (sawtooth metaphysis), celery stalk metaphysis, diaphyseal periostitis, and the separate Wimberger ring sign of scurvy
References
Access all radiology signs posted so far: https://radiogyan.com/radiology-signs/
Improve Content And Help Your Colleagues!
Found an error in the post? Please let us know using our contact page and we will update it with due credits!
If you wish to contribute radiological images for this case (or any other article on the website), you can submit them here and you will be duly credited: Submit radiology case