case_images: PMC4541164_01
case_images: Femoral lesion in a 12-year-old girl who presented with leg pain. (a) Longitudinal gray-scale ultrasound image of the distal femur demonstrates a saucerized cortical defect (the length of the cortical defect is indicated by ultrasound cursor 1), peripheral periosteal reaction (arrow), and oval hypoechoic soft tissue mass (*). (b) Panoramic gray-scale ultrasound image shows the cortical defect (thin arrows) in relation to the femoral shaft and distal epiphyseal plate (thick arrow). (c) Grayscale ultrasound image of the femoral soft tissue mass shows parallel linear hyperechoic structures in the depth of the lesion (dotted lines). (d) Color Doppler image shows blood vessels surrounding and partly obscuring the hyperechoic structures.
case_images: JCIS-5-42-g002.jpg
case_images: PMC4541164_01_JCIS-5-42-g002.jpg
case_images: F1
case_images: Insonation of this area showed a cortical defect with a saucerized appearance and an oval hypoechoic tissue filling the defect and protruding into the adjacent soft tissues [Figure 1a]. Extended field of view showed the defect in relation to the more distal epiphyseal plate [Figure 1b]. In the depths of the soft tissue within the cortical defect, parallel vertical echogenic structures 2.5 to 4.5 mm in height were identified, and color Doppler demonstrated blood vessels coursing between these structures [Figure 1c and d].
case_images: Femoral lesion in a 12-year-old girl who presented with leg pain. Comprehensive imaging of the femur, from left to right, includes (a) plain film and (b) coronal reformatted computed tomography image, both of which show a saucerized cortical lesion (arrow) and a central lytic lesion in the metadiaphysis of the femur (*); (c) coronal proton density fat-saturated magnetic resonance image and (d) coronal T1-weighted contrast enhanced magnetic resonance image which show a soft tissue mass within the cortical lesion (+) and the heterogeneous medullary tumor (M), with post-contrast enhancing nodules (arrow); (e) technetium 99m bone scan which shows tracer uptake at the margins of the cortical lesion (arrow).
case_images: JCIS-5-42-g003.jpg
case_images: PMC4541164_01_JCIS-5-42-g003.jpg
case_images: F2
case_images: A complete imaging workup was performed [Figure 2] and the child was referred to a pediatric oncology center where the diagnosis of telangiectatic osteosarcoma was established.
case_images: (a-c) Femoral lesion in a 12-year-old girl who presented with leg pain. Enlarged images of radiograph and CT of the distal femur. (a) anteroposterior radiograph, (b) axial and (c) coronal CT images do not show a hair-on-end pattern. Codman triangles are indicated by arrows.
case_images: JCIS-5-42-g004.jpg
case_images: PMC4541164_01_JCIS-5-42-g004.jpg
case_images: F3
case_images: A hair-on-end pattern was not identified in either the radiographs or the computed tomographic images of the knee [Figure 3].