Pediatric Radiology

, Volume 35, Issue 6, pp 647–648

Sunburst periosteal reaction in osteogenic sarcoma


  • Megan Gross
    • Department of RadiologyStanford University Medical Center
    • Department of RadiologyStanford University Medical Center
Clinical Image

DOI: 10.1007/s00247-005-1442-6

Cite this article as:
Gross, M. & Stevens, K. Pediatr Radiol (2005) 35: 647. doi:10.1007/s00247-005-1442-6
A 16-year-old boy presented with a recent onset of pain in the right arm. Radiographs of the right shoulder demonstrated an ill-defined, permeative, destructive lesion of the proximal humerus (Fig. 1), with prominent spiculated or sunburst periosteal reaction consistent with a primary osteogenic sarcoma. MRI was also performed to characterize the lesion further and determine the extent of the disease. Axial and coronal fat-saturated T2-weighted FSE images demonstrated florid, circumferential sunburst periosteal reaction, with tumor extending into the joint capsule and bicipital groove (Figs. 2, 3). Tumor and reactive bone-marrow edema extended into the distal humeral shaft, and there was a large associated soft-tissue mass.
Fig. 1


Fig. 2


Fig. 3


Osteosarcoma is a common primary tumor of bone that affects young people in their teens to 20s and can present with pain, swelling, joint complaints, and pathological fractures [1]. Radiographic findings can be lytic, blastic, or mixed, depending on the composition of the tumor. Osteosarcomas are commonly located in the metaphysis of long bones, although they can occur in the axial skeleton. Most tumors have an associated soft-tissue mass as a consequence of direct spread after cortical erosion [1, 2]. Radial and spiculated periosteal reaction is classically seen and referred to as sunburst [1]. Plain films are prerequisites in the initial diagnosis of bone tumors. However, MRI is important for demonstrating the extent of involvement in the marrow and surrounding soft tissues and/or neurovascular spread.

We have chosen to highlight this case because of the florid sunburst periosteal reaction demonstrated on both plain radiographs and MRI. This type of periosteal reaction is characteristically seen in osteogenic sarcoma, but can occasionally be seen in bony metastatic disease [3].

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© Springer-Verlag 2005