Pediatric Nontraumatic Musculoskeletal Lesions: Imaging Pitfalls

Chapter
First Online:

Abstract

Nontraumatic pitfalls in the pediatric musculoskeletal system may arise due to unfamiliarity with the appearance of normal development or variants in the growing child. They may also arise because the imaging features between benign and malignant lesions frequently overlap in children. Pitfalls occurring in the long bones and the axial skeleton, as well as some individual bones, will be addressed. Problems related to the assessment of bone age, bone marrow development, cystic-appearing bone lesions, infection, juvenile inflammatory arthritis, and soft tissue masses will also be discussed.

This is a preview of subscription content, log in to check access.

References

  1. Azouz EM, Saigal G, Rodriguez MM, Podda A (2005) Langerhans’ cell histiocytosis: pathology, imaging and treatment of skeletal involvement. Pediatr Radiol 35:103–115CrossRefPubMedGoogle Scholar
  2. Bancroft LW, Kransdorf MJ, Peterson JJ, O'Connor MI (2006) Benign fatty tumors: classification, clinical course, imaging appearance, and treatment. Skeletal Radiol 35:719–733CrossRefPubMedGoogle Scholar
  3. Bermejo A, De Bustamante TD, Martinez A et al (2013) MR imaging in the evaluation of cystic-appearing soft-tissue masses of the extremities. Radiographics 33:833–855CrossRefPubMedGoogle Scholar
  4. Brown I (1975) A study of the “capsular” shadow in disorders of the hip in children. J Bone Joint Surg Br 57:175–179CrossRefPubMedGoogle Scholar
  5. Caffey J, Madell SH, Royer C, Morales P (1958) Ossification of the distal femoral epiphysis. J Bone Joint Surg Am 40-A:647–654CrossRefPubMedGoogle Scholar
  6. Caird MS, Flynn JM, Leung YL et al (2006) Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am 88:1251–1257PubMedGoogle Scholar
  7. Calfee RP, Sutter M, Steffen JA, Goldfarb CA (2010) Skeletal and chronological ages in american adolescents: current findings in skeletal maturation. J Child Orthop 4:467–470CrossRefPubMedPubMedCentralGoogle Scholar
  8. Cheema JI, Grissom LE, Harcke HT (2003) Radiographic characteristics of lower-extremity bowing in children. Radiographics 23:871–880CrossRefPubMedGoogle Scholar
  9. Damasio MB, Malattia C, Tanturri de Horatio L et al (2012) MRI of the wrist in juvenile idiopathic arthritis: proposal of a paediatric synovitis score by a consensus of an international working group. Results of a multicentre reliability study. Pediatr Radiol 42:1047–1055CrossRefPubMedGoogle Scholar
  10. Gebarski K, Hernandez RJ (2005) Stage-I osteochondritis dissecans versus normal variants of ossification in the knee in children. Pediatr Radiol 35:880–886CrossRefPubMedGoogle Scholar
  11. Ghelman B, Freiberger RH (1976) The limbus vertebra: an anterior disc herniation demonstrated by discography. AJR Am J Roentgenol 127:854–855CrossRefPubMedGoogle Scholar
  12. Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, StanfordGoogle Scholar
  13. Grimm NL, Weiss JM, Kessler JI, Aoki SK (2014) Osteochondritis dissecans of the knee: pathoanatomy, epidemiology, and diagnosis. Clin Sports Med 33:181–188CrossRefPubMedGoogle Scholar
  14. Harel L, Kornreich L, Ashkenazi S et al (1999) Meyer dysplasia in the differential diagnosis of hip disease in young children. Arch Pediatr Adolesc Med 153:942–945CrossRefPubMedGoogle Scholar
  15. Helms CA (2014) “Don’t touch” lesions. In: Helms CA (ed) Fundamentals of skeletal radiology, 4th edn. Elsevier, PhiladelphiaGoogle Scholar
  16. Henninger B, Glodny B, Rudisch A et al (2013) Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging. Skeletal Radiol 42:1097–1104CrossRefPubMedGoogle Scholar
  17. Ho VB, Kransdorf MJ, Jelinek JS, Kim CK (1991) Dorsal defect of the patella: MR features. J Comput Assist Tomogr 15:474CrossRefPubMedGoogle Scholar
  18. Hoerr NL, Pyle SI, Francis CC (1962) Radiographic atlas of skeletal development of the foot and ankle. Charles C Thomas, SpringfieldGoogle Scholar
  19. Jee WH, Choi KH, Choe BY et al (1996) Fibrous dysplasia: MR imaging characteristics with radiopathologic correlation. AJR Am J Roentgenol 167:1523–1527CrossRefPubMedGoogle Scholar
  20. von Kalle T, Stuber T, Winkler P et al (2015) Early detection of temporomandibular joint arthritis in children with juvenile idiopathic arthritis - the role of contrast-enhanced MRI. Pediatr Radiol 45:402–410CrossRefGoogle Scholar
  21. Karlo CA, Stolzmann P, Habernig S et al (2010) Size, shape and age-related changes of the mandibular condyle during childhood. Eur Radiol 20:2512–2517CrossRefPubMedGoogle Scholar
  22. Keats EK, Strouse PJ (2008) Anatomic variants. In: Slovis TL (ed) Caffey’s pediatric diagnostic imaging, 11th edn. Mosby, PhiladelphiaGoogle Scholar
  23. Khanna M, Delaney D, Tirabosco R, Saifuddin A (2008) Osteofibrous dysplasia, osteofibrous dysplasia-like adamantinoma and adamantinoma: correlation of radiological imaging features with surgical histology and assessment of the use of radiology in contributing to needle biopsy diagnosis. Skeletal Radiol 37:1077–1084CrossRefPubMedGoogle Scholar
  24. Khanna G, Sato TS, Ferguson P (2009) Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 29:1159–1177CrossRefPubMedGoogle Scholar
  25. Kleinman PK, Belanger PL, Karellas A, Spevak MR (1991) Normal metaphyseal radiologic variants not to be confused with findings of infant abuse. AJR Am J Roentgenol 156:781–783CrossRefPubMedGoogle Scholar
  26. Kobayashi K, Burton KJ, Rodner C et al (2004) Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg 12:246–254CrossRefPubMedGoogle Scholar
  27. Kuhns LR, Poznanski AK, Harper HA, Garn SM (1973) Ivory epiphyses of the hands. Radiology 109:643–648CrossRefPubMedGoogle Scholar
  28. Kwon DS, Spevak MR, Fletcher K, Kleinman PK (2002) Physiologic subperiosteal new bone formation: prevalence, distribution, and thickness in neonates and infants. AJR Am J Roentgenol 179:985–988CrossRefPubMedGoogle Scholar
  29. Lachman RS, Krakow D, Cohn D et al (2005) MED, COMP, multilayered and NEIN: an overview of multiple epiphyseal dysplasia. Pediatr Radiol 35:116–123CrossRefPubMedGoogle Scholar
  30. Limb D, Loughenbury PR (2012) The prevalence of pseudoepiphyses in the metacarpals of the growing hand. J Hand Surg Eur 37:678–681CrossRefGoogle Scholar
  31. Love C, Din AS, Tomas MB et al (2003) Radionuclide bone imaging: an illustrative review. Radiographics 23:341–358CrossRefPubMedGoogle Scholar
  32. Mulligan PR, Prajapati HJ, Martin LG, Patel TH (2014) Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches. Br J Radiol 87:20130392CrossRefPubMedPubMedCentralGoogle Scholar
  33. Murphey MD, Carroll JF, Flemming DJ et al (2004) From the archives of the AFIP: benign musculoskeletal lipomatous lesions. Radiographics 24:1433–1466CrossRefPubMedGoogle Scholar
  34. Nadvi SZ, Kottamasu SR, Bawle E, Abella E (1999) Physiologic osteosclerosis versus osteopetrosis of the newborn. Clin Pediatr (Phila) 38:235–238CrossRefGoogle Scholar
  35. Nistala H, Mäkitie O, Jüppner H (2014) Caffey disease: new perspectives on old questions. Bone 60:246–251CrossRefPubMedGoogle Scholar
  36. O’Donnell P, Saifuddin A (2004) The prevalence and diagnostic significance of fluid-fluid levels in focal lesions of bone. Skeletal Radiol 33:330–336CrossRefPubMedGoogle Scholar
  37. Ording Muller LS, Boavida P, Avenarius D et al (2013) MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study. Pediatr Radiol 43:785–795CrossRefPubMedGoogle Scholar
  38. Ozonoff MB (1992a) The foot. In: Ozonoff MB (ed) Pediatric orthopedic radiology, 2nd edn. WB Saunders, PhiladelphiaGoogle Scholar
  39. Ozonoff MB (1992b) The hip. In: Ozonoff MB (ed) Pediatric orthopedic radiology, 2nd edn. WB Saunders, PhiladelphiaGoogle Scholar
  40. Ozonoff MB (1992c) The spine. In: Ozonoff MB (ed) Pediatric orthopedic radiology, 2nd edn. WB Saunders, PhiladelphiaGoogle Scholar
  41. Pai DR, Strouse PJ (2011) MRI of the pediatric knee. AJR Am J Roentgenol 196:1019–1027CrossRefPubMedGoogle Scholar
  42. Prenger EC, Ball WS (1991) Spine and contents. In: Kirks DR (ed) Practical pediatric imaging: diagnostic radiology of infants and children. Little Brown and Co, BostonGoogle Scholar
  43. Pyle SI, Hoerr NL (1969) A radiographic standard of reference for the growing knee. Charles C Thomas, SpringfieldGoogle Scholar
  44. Raber SA (1999) The dense metaphyseal band sign. Radiology 211:773–774CrossRefPubMedGoogle Scholar
  45. Rachel JN, Williams JB, Sawyer JR et al (2011) Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (Sever’s disease)? J Pediatr Orthop 31:548–550CrossRefPubMedGoogle Scholar
  46. Sakamoto FA, Winalski CS, Schils JP et al (2011) Vacuum phenomenon: prevalence and appearance in the knee with 3T magnetic resonance imaging. Skeletal Radiol 40:1275–1285CrossRefPubMedGoogle Scholar
  47. Scanderbeg AC, Dallapicolla B (2001) Congenital defects, malformation syndromes and skeletal dysplasias. In: Guglielmi G, Van Kuijik C, Genant HK (eds) Fundamentals of hand and wrist imaging. Springer, BerlinGoogle Scholar
  48. Shabshin N, Schweitzer ME, Morrison WB et al (2006) High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes? Pediatr Radiol 36:670–676CrossRefPubMedGoogle Scholar
  49. Shah ZK, Peh WCG, Koh WL, Shek TWH (2005) Magnetic resonance imaging appearances of fibrous dysplasia. Br J Radiol 78:1104–1115CrossRefPubMedGoogle Scholar
  50. Smith JD, Jaramillo D (2008) Osteochondroses. In: Slovis TL (ed) Caffey’s pediatric diagnostic imaging, 11th edn. Mosby, PhiladelphiaGoogle Scholar
  51. Struhl S, Edelson C, Pritzker H et al (1989) Solitary (unicameral) bone cyst. The fallen fragment sign revisited. Skeletal Radiol 18:261–265CrossRefPubMedGoogle Scholar
  52. Swischuk LE, Swischuk PN, John SD (1993) Wedging of C-3 in infants and children: usually a normal finding and not a fracture. Radiology 188:523–526CrossRefPubMedGoogle Scholar
  53. Teo HEL, Peh WCG, Akhilesh M, Tan SB, Ishida T (2007) Congenital osteofibrous dysplasia associated with pseudoarthrosis of the tibia and fibula. Skeletal Radiol 36(Suppl 1):S7–14CrossRefPubMedGoogle Scholar
  54. Thapa MM, Chaturvedi A, Iyer RS et al (2012a) MRI of pediatric patients: part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol 198:W456–W465CrossRefPubMedGoogle Scholar
  55. Thapa MM, Iyer RS, Khanna PC, Chew FS (2012b) MRI of pediatric patients: part 1, normal and abnormal cartilage. AJR Am J Roentgenol 198:W450–W455CrossRefPubMedGoogle Scholar
  56. Tsung JW, Blaivas M (2008) Emergency department diagnosis of pediatric hip effusion and guided arthrocentesis using point-of-care ultrasound. J Emerg Med 35:393–399CrossRefPubMedGoogle Scholar
  57. Vande Berg BC, Malghem J, Lecouvet FE et al (1998) Magnetic resonance imaging of the normal bone marrow. Skeletal Radiol 27:471–483CrossRefPubMedGoogle Scholar
  58. Wakely SL (2006) The posterior vertebral scalloping sign. Radiology 239:607–609CrossRefPubMedGoogle Scholar
  59. Weger C, Frings A, Friesenbichler J et al (2013) Osteolytic lesions of the calcaneus: results from a multicentre study. Int Orthop 37:1851–1856CrossRefPubMedPubMedCentralGoogle Scholar
  60. Wipff J, Adamsbaum C, Kahan A, Job-Deslandre C (2011) Chronic recurrent multifocal osteomyelitis. Joint Bone Spine 78:555–560CrossRefPubMedGoogle Scholar
  61. Wu JS, Hochman MG (2009) Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology 253:297–316CrossRefPubMedGoogle Scholar
  62. Zember JS, Rosenberg ZS, Kwong S et al (2015) Normal skeletal maturation and imaging pitfalls in the pediatric shoulder. Radiographics 35:1108–1122CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Diagnostic Imaging and InterventionKK Women’s and Children’s HospitalSingaporeRepublic of Singapore

Personalised recommendations