The main objective in this review of 46 cases of congenital syphilis has been to analyze and evaluate the roentgenographic findings. The material was collected at the State University and Crippled Children's Hospitals. It includes 19 males and 27 females; 32 white and 14 colored patients. Their ages ranged from the newborn child up to nineteen years. Twenty patients were older than one year, and 26 were younger. Of the latter group, 20 were less than five months of age. Serologic tests were reported positive in 43 cases, negative in 2, and in 1 case the specimen was destroyed. The cerebrospinal fluid was examined 16 times and found positive in only 1 instance. For the sake of brevity, we have intentionally omitted from consideration stillbirths and syphilitic fetuses. Although many of these patients were examined in our Outpatient Department and only brief records were available, the following clinical findings were noted: snuffles and skin rashes in 13 cases; pseudoparalysis in 11; adenopathy, enlargement of the liver and spleen in 10; saber shin in 10; keratitis in 3; and draining bone lesions in 2. In 3 patients pyogenic osteomyelitis was suspected; scurvy in 2; Ewing's tumor in 2; osteogenic sarcoma in 1; sickle-cell anemia in 1; Hodgkin's disease in 1; neuroblastoma in 1. In reviewing the x-ray findings, the bone lesions were listed individually as shown in Table I, although in the great majority of cases a combination of lesions was present. Thus, periostitis could be detected in 42 cases, osteochondritis in 21, osteitis in 17, and osteomyelitis in 11. There were 5 pathological fractures in the entire series. As appears from the table, the most prevalent lesion in very young infants was osteochondritis with an associated periostitis. The incidence of periostitis as the sole lesion was approximately one-third as high. Two pathological fractures were observed in this group. In older children, osteitis and osteomyelitis, associated with lesions of other types, occurred in almost equal proportions. Among these older patients there were 3 pathological fractures. Osteochondritis In syphilitic infants of less than one year of age, the pathognomonic lesion seen on roentgen examination is osteochondritis, accompanied in most instances by periostitis. These lesions tend to have a symmetrical distribution, although they vary considerably in appearance and extent. In severe cases the destructive process is so extensive about the growing ends of the long bones that metaphyseal fractures occur. It is this type of involvement that is responsible for the clinical picture of Parrot's pseudoparalysis. In other cases the metaphyses have a “zigzag” or “saw-tooth” appearance, while in milder cases only a portion of the metaphysis is involved. All of the above lesions are considered pathognomonic. When, however, osteogenesis is interfered with to a lesser degree, the x-ray findings are considered as merely suggestive of syphilis.
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Oct 1, 1951
Mary Huber 
