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Kamsi
Forum Guru Topics: 102 Posts: 334 |
A 7-year-old boy who has had pain in his right leg for 4 months is being evaluated in the pediatric clinic. The pain is worse at night and is unrelenting, but it can usually be relieved with ibuprofen. According to his parents, he is a physically active child and plays basketball and little league softball. On physical examination, there is localized tenderness over the anterior aspect of the right thigh. There is also mild atrophy of the affected limb. A radiograph of the femur reveals a radiolucent nidus with surrounding reactive sclerotic bone. Which of the following is the most likely diagnosis? A. Brodie's abscess B. Ewing sarcoma C. Osteosarcoma D. Osteoid osteoma E. Stress fracture
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DrVirgo
| Forum Junior Topics: 731 Posts: 3487
A. Brodie's abscess The clues are: pain is worse at night usually be relieved with ibuprofen localized tenderness reactive sclerotic bone
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Doc750
| transfer:step 3 prison Topics: 53 Posts: 628
Agreed A. Brodie's abscess. Also look for the classic presentation of a draining abscess extending from the tibia out through the shin
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titly
| Forum Elite Topics: 25 Posts: 394
not stress fracture??
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hanialkhadher
| Forum Elite Topics: 18 Posts: 259
D. Osteoid osteoma
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cinammonice
| Forum Newbie Topics: 1 Posts: 8
D
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DrVirgo
| Forum Junior Topics: 731 Posts: 3487
What makes you say D? Can you please explain? Kamsi, what's the answer?
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bigdino
| Forum Newbie Topics: 2 Posts: 15
Typical picture of osteoid osteoma. He is a child with pain worsening at nights, relieved by NSAIDs, radiolucent nidus and reactive sclerosis (Classic radiologic finding; i am a radiologist so I better know about). I suppose being a physically active child would exclude an abscess.
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DrVirgo
| Forum Junior Topics: 731 Posts: 3487
bigdino wrote: Typical picture of osteoid osteoma. He is a child with pain worsening at nights, relieved by NSAIDs, radiolucent nidus and reactive sclerosis (Classic radiologic finding; i am a radiologist so I better know about). I suppose being a physically active child would exclude an abscess. Thanks for the explanation, I appreciate your input as a radiologist. Just wondering -aren't these findings also present in Brodie's abscess? How can we rule that one out? Thankls.
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bigdino
| Forum Newbie Topics: 2 Posts: 15
They actually look quite similar on radiography and they would be included in the radiological differential. But the pain that gets worse at night is so classic of osteoid osteoma. Brodie's abscess is not associated with that nocturnal pain. Hope that helps
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kpmle2
| Forum Guru Topics: 95 Posts: 503
D. Osteoid osteoma
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me007
| Forum Guru Topics: 72 Posts: 781
http://bonetumor.org/tumors/pages/page13.html www.e-radiography.net/radpa...path/b/brodies_abscess.htm
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DrVirgo
| Forum Junior Topics: 731 Posts: 3487
Thanks... still a bit confused... This is from emedicine about Brodie's Abscess: http://www.emedicine.com/orthoped/topic27.htm "Night pain that is relieved with aspirin is frequently reported." "On clinical examination, localized tenderness may only occasionally be associated with warmth, redness, and soft tissue swelling with the involvement of subcutaneous bone." "Type Ia lesions present as a punched out radiolucency often suggestive of eosinophilic granuloma. Type Ib lesions are similar to type Ia lesions but have a sclerotic margin and appear as a classic Brodie abscess."
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neuroblastoma
| Forum Guru Topics: 123 Posts: 1111
yes D BECAUSE...IN BRODIES ABCESS-Minimal loss of function is another common symptom (eg, limping in a patient with a lower limb lesion), in ques- physically active child
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Kamsi
| Forum Guru Topics: 102 Posts: 334
D Osteoma from d hx of nocturnal pain n X-ray finding of radiolucent nidus with surrounding reactive sclerotic bone.
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DrAlex_76
| Forum Guru Topics: 120 Posts: 408
wata question !
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mytime
| Go Marching in! Topics: 40 Posts: 3161
Yes, D!!!!!!!!!!
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Ivonne
| IM PGY-3 Topics: 57 Posts: 1641
UW question a nice one
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