Cone-Shaped Epiphyses

Cone-shaped epiphyses (coned epiphyses) are epiphyses that invaginate into cupped metaphyses. They are more commonly found in the feet as a morphological variant, but can also be associated with symptoms or be seen with a variety of developmental disorders. Differential considerations for cone-shaped epiphyses include normal variant and ABCD MOST:

• Normal variant (shown above in three different patients)
• Achondroplasia, Acrodysostosis
• Beckwith Wiedemann syndrome
• Chondroplasia punctata, Cockayne syndrome, Conorenal syndrome (Mainzer-Saldino syndrome, association of chronic renal failure and phalangeal cone-shaped epiphyses of the hands), Cleidocranial dysplasia, Cartilage-hair hypoplasia
• Dactylitis, Dyggve-Melchior-Clausen syndrome
• Multiple epiphyseal dysplasia
• Osteomyelitis
• Sickle cell disease
• Thermal injury, Trichorhinophalangeal syndrome

References

• Freyschmidt J, Brossmann J, Wiens J, Sternberg A. The Hand - General Aspects. In Freyschmidt's Köhler and Zimmer: Borderlands of normal and early pathologic findings in skeletal radiography. Fifth revised edition. Thieme (2003). Pp 24-26.
• Differential Diagnosis in Pediatric Radiology. Edited by Ebel KD, Blickman H, Willich E, Richter E. Thieme. Stuttgart, New York, 1999.
• Medcyclopaedia.