institute of evolutionary medicine – faculty of medicine … · 2018-05-16 · institute of...

Institute of Evolutionary Medicine – Faculty of Medicine

9/27/2016

Musculoskeletal pathologies and anatomical variants in ancient Egyptian mummies Radiological findings in Ancient Egyptian Mummies from Swiss Collections Case report/ series: CR040 Lena Öhrström1,2, Roger Seiler1, Francesco Galassi1, Thomas Böni1,3 and Frank Rühli1

1 Swiss Mummy Project, Institue of Evolutionary Medicine, Faculty of Medicine, University of Zurich, Switzerland; Email: [email protected] 2 Dept. of Internal Medicine and Nephrology, Klinik Hirslanden, Zurich, Switzerland

3 Orthopedic University Hospital Balgrist, Zurich, Switzerland

Institute of Evolutionary Medicine - Faculty of Medicine

Content

• Evidence for musculoskeletal disease in Ancient Egypt

• Material & Methods

• Ancient Egyptian mummies from Swiss collections & radiological findings & interpretation

• Conclusion

9/27/2016 Musculosceletal pathologies in Ancient Egyptian Mummies, Öhrström et al.


Evidence for musculoskeletal pathologies in Ancient Egypt


• Congenital: skeletal dysplasia (Kozma C, 2008); hydrocephalus (El Batrawi,1935; Ciranni et al 2005)

• Traumatic: multiple cases described, multiple references

• Infectious: tuberculosis (Raven et al., 2008, Zink 2003); Leprosy (Molto 2002)

• Neoplastic: meningeoma (Appenzeller &Aufderheide r 1999, York & Steinberg, 2010); osteoma (Filer, 1998); Multiple Myeloma (Zink et al 1999, Nerlich & Zink, 2003, Dunand, Ibrahim et al., 2008); metastases (Zink et al, 1999)

• Degenerative: multiple cases of osteoarthritis (Fritsch 2015)

• Historic records: Medical papyri (written sources from ancient Egypt)

• mainly traumatic cases (eg. The Edwin Smith papyrus describes 27 head injuries)

• Case reports of Egyptian mummies & skeletal remains



Material & Methods Analyses of CT-scans of several ancient Egyptian mummies from Swiss museums and collections: Musée d’éthnographie, Neuchâtel , Rätisches Museum Chur, Bernisches Naturhistorisches Museum, Musée d’Yverdon et Région, Museum of art and history, Geneva, Naturhistorisches Museum Basel, Musée d'Archéologie et d'Histoire, Lausanne CT-scans were performed at the nearby hospital (Toshiba Aquilon, EHNV Yverdon), the Balgrist Univerisity Hospital Zurich (Siemens, Somatom Plus) or at the Institute of Forensic Medicine, Zurich (Siemens, Somatom Definition Flash) Imaging parameters: • 0,5 -3 mm slice thickness • 80-120 kV • 198 – 475 mA X-ray Tube current • 512 x 512 matrix size / 0.625 x 0.625 inches pixel spacing


Nacht-ta-Natjeret


Radiological findings: • subchondral cysts in patellar and femoral bone as well as subchondral sclerosis

Musée d’éthnographie, Neuchâtel Acc-no: Eg 185c Provenance: Thebes west Historical age: 21/22. dynasty Individual age: adult Sex: m



Nacht-ta-Natjeret

Radiological findings: • multiple subchondral cysts in both scapulae, right > left, with well-defined margins, no subchondral sclerosis, intact humeral head


Interpretation


Osteoarthritis of the knee: femoro-patellar osteoarthritis • Prevalence: widespread, especially older people > indicates older age of

mummy • Symptoms: stress-related pain, intensified while ambulating downhill • Differential diagnoses: Calcium pyrophosphate dihydrate disease (CPPD

disease) Benign bone cysts • Symptoms: mostly asymptomatic, incidental finding; sometimes cysts can

cause pathologic fracture • Differential diagnoses: Aneurysmal bone cyst: unlikely, primarily seen in

children and adolescents, expansile growth, scapula not typically affected


Neshou - priest mummy


Musée d’Yverdon et Région Acc-no: MY/3775 Provenance: Achmim Historical age: ptolemaic, approx. 300-200AD Individual age: adult, approx. 50 years Sex: m

Radiological findings: • osteophyte formation cervical level 5-6


Neshou - priest mummy


Radiological findings: • right scapula with several subchondral cysts and subchondral sclerosis


Interpretation

Cervical column with osteophyte formation • Most likely degenerative changes > indicates older age of the mummy

Omarthrosis • Prevalence: very common • Etiology: degenerative changes • Differential diagnoses: posttraumatic, post-inflammatory > both findings indicate older age of the mummy 9/27/2016 Musculosceletal pathologies in Ancient Egyptian Mummies, Öhrström et al.


Anonymous male mummy


Musée d'Archéologie et d'Histoire, Lausanne Acc-no: 000491 Provenance: unknown Historical age: 1000-800 BC Individual age: adult Sex: m

Radiological findings: • 3rd / 4th lumbar vertebra with ventral osteophyte formation • rest of vertebral column without pathologies



Anonymous male mummy

Radiological findings: • left acetabulum and femoral head with several cysts with well-defined margin, subchondral sclerosis

axial coronal


Interpretation


Degenerative changes lumbar vertebral column • Etiology: most likely degenerative Coxarthritis • Prevalence: very common • Etiology: most likely degenerative • Differential diagnoses: posttraumatic, post-iflammatory > both findings indicate older age of mummy


Ta-di-Isis


Rätisches Museum, Chur Acc-no: K1205 Provenance: Thebes Historical age: approx. 700 BC Individual age: adult Sex: presumably female


Ta-di-Isis


Radiological findings: • 4th lumbar vertebra with corduroy sign / polka dot sign • rest of vertebral column without pathologies

4th lumbar vertebra


Interpretation

Vertebral hemangioma • Benign vascular tumour • Prevalence: very common, found in ca. 10% of autopsies • Symptoms: usually asymptomatic, incidential finding, seldom leads to

collapse of the vertebral body

• Differential diagnoses: metastases > unlikely, no destructive growth. 4th lumbar vertebra with typical signs for hemagioma (polka dot / corduroy sign)



Anonymous mummy (ptolemaic time period)


Bernisches Naturhistorisches Museum (on loan to Anthropologisches Museum Zürich) Acc-no: AE 1 Provenance: unknown Historical age: ptolemaic, 305 – 30 BC Individual age: adult Sex: m

Radiological findings: • right ankle with single well defined subtalar cyst, rand sclerosis • no subchondral sclerosis


Anonymous mummy (ptolemaic time period)


Radiological findings: • left acetabulum shows multiple well defined subchondral cysts and subchondral sclerosis


Coxarthritits • Prevalence: very common • Etiology: most likely degenerative > indicating older age of mummy • Differential diagnosis: posttraumatic, post-inflammatory Single benign bone cyst right ankle

• Etiology: idiopathic, posttraumatic • Symptoms: asymptomatic or stress related pain 9/27/2016 Musculosceletal pathologies in Ancient Egyptian Mummies, Öhrström et al.

Interpretation


Lady Tches-Mout-peret (1070 BC – 664 BC)


coronal slice

Museum of art and history, Geneva Acc-no: D 242 Provenance: Thebes Historical age: 1070 -664BC Individual age: 40 -50 years Sex: f

Radiological findings: • Bilateral thinning of parietal bone (ellipsoid) • right side: ca. 6 x 5.5 cm • left side: ca. 5.5 x 4.5 cm • only thin bone coverage in the centre of the thinned areas (ca. 1mm)

coronal


Lady Tches-Mout-peret (1070 BC – 664 BC)


axial coronal

Radiological findings: • oval lesion in the centre of the right depression (diameter 4 cm)


Biparietal thinning, perforated on one side • Normal variant, usually bilateral thinning in parietal bones (resorption in outer table of bone, inner table usually intact) • Prevalence: ca. 0,4% of normal skulls, f > m, age: > 60 • Symptoms: no clinical signs, mostly incidental finding • Perforation: the skull was probably opened during the embalming

procedure. (e.g.removal of brain, placing of teeth) • Differential diagnoses: metastatic > unlikely, since lesion is bilaterally

and symmetric


Interpretation


Anonymous mummified head (Late period 664 - 332 BC)


Musée d’éthnographie, Neuchâtel Acc.no: EG 496 Provenance: unknown Historical age: Late Period (664-332 BC) Individual age: early adult, < 30y

MPR


Anonymous mummified head (Late period 664 - 332 BC) Osteom sinus frontalis


MPR sagittal

axial slice

coronal slice MPR coronal

Radiological findings: Localized mass of mature bone, well-defined margins, Sinus frontalis


Interpretation

Osteoma (benign tumour) • benign growths of dense cortical bone • most commonly seen in the paranasal sinuses (frontal) or cranium • grow slowly and rarely expand internally to compress the brain • Prevalence: ca. 1% • Symptoms: usually asymptomatic; possible headache (retained

secretion)



Anonymous mummified head, undated


Naturhistorisches Museum, Basel Acc.no: III 6999 Provenance: Valley of the Kings Historical age: undated, estimated 19th Dynasty Individual age: adult


Anonymous mummified head, undated


axial slice

sagittal slice sagittal slice

Radiological findings: multiple well-defined lytic lesions, no margin-sclerosis, ill-defined rims


Interpretation

Multiple Myeloma • malign tumour (proliferation of plasmacytes) • infiltration of bone marrow • bone destruction: affects skull, spine, ribs, pelvis • Prevalence: ca. 1% of all tumours ; 3-5 / 100000 Residents/year • Age: around 65 years, seldom < 40 years • Symptoms: fatigue (anemia), bone pain, pathologic fractures, infection

susceptibility (deficit of Immunoglobullins), renal disease • Differential diagnoses: metastases, (MM is more widespread; more

discrete holes in MM) 9/27/2016 Musculosceletal pathologies in Ancient Egyptian Mummies, Öhrström et al.


Conclusion

• Evidence for multiple musculoskeletal disease and anatomical norm variants in Ancient Egypt

• Various cases of musculoskeletal pathologies found in Swiss Museum collections

• CT is an ideal diagnostic Imaging modality for detection of skeletal disese in historic specimen and often diagnosis can be established by radiological information

• However: Interpretation of symptoms with caution (lack of medical reports/ lack of further diagnostic such as blood analysis)



Author disclosures

• The authors state no conflict of interests

• No financial disclosures



Acknowledgements

• Mäxi Foundation for their continued generous support • Balgrist University Hospital and Institute of Forensic Medicine (IRM)

Zürich for supporting CT Imaging • Swiss Museums for providing CT data (Musée d’éthnographie, Neuchâtel ,

Rätisches Museum Chur, Bernisches Naturhistorisches Museum, Musée d’Yverdon et Région, Museum of art and history, Geneva, Naturhistorisches Museum Basel, Musée d'Archéologie et d'Histoire, Lausanne)

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http://www.iem.uzh.ch/en/institute/iemcodeofethics.html

Contact and updates through: http://evolutionarymedicine.ch http://swissmummyproject.ch


institute of evolutionary medicine – faculty of medicine … · 2018-05-16 · institute of...

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