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11 year old girl with left ankle sprain

Case Identification
Case ID Number: 
20091105ER
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This 11 year old girl presented to the local emergency room after she sprained her ankle in soccer. In your office 4 days later, she has local tenderness and swelling at the level of the joint line anterior to the distal part of the fibula.

Treatment for this patient consisted of 1) functional rehabilitation for the ankle sprain. 2) Observation with follow-up exams and radiographs for the tumor. See below for follow-up radiographs one year later and two years later. Click on the images for a better view.

Radiological findings:: 
The lesion is still present, but no growth or progression has occurred. Longitudinal growth of the bone has made the lesion seem to move away from the growth plate. The lesion shows no evidence of progression or aggressive behavior. It seems to have become smaller, but this is likely to be due to relative increase in size of the tibia due to continued growth. The lesion seems to have moved farther away from the growth plate. This lesion is likely to involute after skeletal maturity
Special Features of this Case:: 
In this case, it was felt that the tumor had no causal relationship with the sprained ankle, and that this lesion did not pose a threat of pathological fracture that was high enough to warrant surgical treatment. The patient was allowed to continue to play soccer and participate fully in gym class.
Image Reference: 

12 year old boy with right elbow pain and stiffness

Case Identification
Case ID Number: 
20091105AR
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 12 year old boy was referred from outside center following a three week history of worsening right elbow pain.In addition to the pain, the patient also had significantly reduced range of motion, and when seen in the clinic had only 20 degree range of active motion. His elbow is remarkably tender with significant effusion also.

Image Reference: 

32 year old man with pain in the knee

Case Identification
Case ID Number: 
20090709pk
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 32 year old man presented with pain in the lateral aspect of his knee for six weeks. He had no history of injury and was otherwise healthy. Radiographs and bone scan are shown at right.

Laboratory results:: 
Labs were normal.
Differential Diagnosis: 
The differential should include active bone tumors that are likely to occur around the knee of an adult. The possibilities include aneurysmal bone cyst, eosinophilic granuloma, giant cell tumor, lymphoma, and infection. Tumors and lesions that might occur in this setting but are less likely include hyperparathyroidism, osteosarcoma, Ewing's sarcoma, myeloma, lymphoma, angiosarcoma, adamantinoma, and fibrous dysplasia.

50 year old tennis player with pain in the knee .

Case Identification
Case ID Number: 
20091117AD
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

The patient is a very pleasant woman who is an active tennis player and 50 years of age. She has had aching pain in the left knee and a radiograph revealed a bone lesion in the proximal tibia. The patient is seen at the request of her orthopedic surgeon.

Radiological findings:: 
The patient is generally healthy. She is currently taking no medicines. There is no family history of bone lesions or bone tumors. On detailed examination, the patient is in no acute distress, and is oriented to time, place, and person. Examination of the right knee shows normal appearance. There is no effusion. There is no erythema or swelling, no ecchymosis or bruising noted. The alignment of the knee is normal. The range of motion is full. In the proximal tibia there is no mass palpable. There is no tenderness over the proximal bone. There is no erythema or sign of inflammation. There is no popliteal adenopathy, no inguinal adenopathy, and no cervical adenopathy. The skin is normal and there is no cafe au lait spots.
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