• María I. Martínez León
  • Juan E. Gutiérrez
  • Luisa Ceres Ruiz
Part of the Learning Imaging book series (LEARN)


A 6-year-old boy presented a 3-months history of right hip pain. Synovitis of the hip was initially diagnosed, and X-ray were normal. Three months later a slight pain in the hip persisted, and a limitation of joint motion was evident at physical examination. X-ray and MRI at this time revealed evidence of osteonecrosis of the right femoral head.


Femoral Head Plain Radiography Lytic Lesion Periosteal Reaction Primitive Neuroectodermal Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Further Reading


  1. Barkovich JA (2005) Pediatric neuroimaging. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  2. Labrune M, Kalifa G (2000) Diagnóstico por imagen de la columna vertebral en la infancia. Colección de diagnóstico por imagen. Ed Masson SA, BarcelonaGoogle Scholar
  3. Parizel PM, Vanhoenacker FM (2006) Imaging of soft tissue tumors, 3rd edn. Springer, New York, p 227Google Scholar
  4. Resnick D (2001a) Bone and joint imaging, vol II. W.B. Saunders, Philadelphia, p 667Google Scholar
  5. Resnick D (2001b) Bone and joint imaging, 2nd edn. W.B. Saunders, PhiladelphiaGoogle Scholar
  6. Resnick D. (2005) Diagnosis of bone and joint disorders, vol 5, 3rd edn. W.B. Saunders, Philadelphia, Chapter 81, pp 3559–3610Google Scholar
  7. Resnick D. (2005) Diagnosis of bone and joint disorders, 3rd edn. W.B. Saunders, PhiladelphiaGoogle Scholar
  8. Silverman FN, Kuhn JP (1993) Caffey’s pediatric X-ray diagnosis. An integrated imaging approach, 9th edn. Mosby, St. Louis, p 1850Google Scholar
  9. Stoller DW, Tirman PF, Bredella MA, Beltrán S, Branstetter RM, Blease SC (2004) Diagnostic imaging. Orthopedics, vol 8. Amirsys, pp 14–17, Salt Lake City, Utah: AmirsysGoogle Scholar
  10. Stoller DW, Tirman PFJ, Bredella MA, Beltrán S, Branstetter RM, Blease SC (2004) Diagnostic imaging. Orthopedics. Amirsys, pp 814–817, Salt Lake City, Utah: AmirsysGoogle Scholar


  1. Anik Y, Corapcioglu F, Yildiz DK (2008) Radiological findins of atypical extraoskeletal Ewing sarcoma. Pediatr Hematol Oncol 25:469–471PubMedGoogle Scholar
  2. Averill LW, Hernandez A, Gonzalez L, Peña AH (2009) Jaramillo D Diagnosis of osteomyelitis in children: utility of fat-suppressed contrast-enhanced MRI. AJR 192:1232–1238PubMedGoogle Scholar
  3. Baleato Gonzalez S, Vilanova JC, García Figueras R (2008) The role of MRI in the early diagnosis of pyomyositis in children. Radiología 50:495–501PubMedGoogle Scholar
  4. Bansal M, Bhaliak V, Bruce CE (2008) Obturator internus muscle abscess in a child. A case report. J Pediatr Orthop B 17:223–224PubMedGoogle Scholar
  5. Benesch M, Christian U, Herwig L, Reinhold K, Wolfgang S, Christine B-S et al (1999) Typical extraosseous Ewing sarcoma of the spinal canal with bone marrow involvement in a two-month-old boy. Med Pediatr Oncol 32(6):471PubMedGoogle Scholar
  6. Bestic JM, Peterson JJ, Bancroft LW (2009) Use of FDG PET in staging, restaging, and assessment of therapy response in Ewing sarcoma. RadioGraphics 29:1487–1500PubMedGoogle Scholar
  7. Bodart E, Motte F, Michel M (2008) Limp with fever in adolescent: about 2 cases of pyomyositis. Arch Pediatr 15:1304–1307PubMedGoogle Scholar
  8. Brown R, Hussain M, McHugh K, Novelli V, Jones D (2001) Discitis in young children. J Bone Joint Surg Am 83:106–111Google Scholar
  9. Browne LP, Mason EO, Kaplan SL (2008) Optimal imaging strategy for community-adquired Staphylococcus aureus musculoskeletal infections in children. Pediatr Radiol 38:841–847PubMedGoogle Scholar
  10. Buchmann RF, Jaramillo D (2004) Imaging of articular disorders in children. Radiol Clin North Am 42:151–168PubMedGoogle Scholar
  11. Campidelli C, Agostinelli C, Stitson R, Pileri SA (2009) Myeloid sarcoma: extramedullary manifestation of myeloid disorders. Am J Clin Pathol 132(3):426–437PubMedGoogle Scholar
  12. Carr AJ, Cole WG, Roberton DM, Chow CW (1993) Chronic multifocal osteomyelitis. J Bone Joint Surg Br 75:582–591PubMedGoogle Scholar
  13. Chan LL, Czerniak BA, Ginsberg LE (2000) Radiation-induced osteosarcoma after bilateral childhood retinoblastoma. AJR 174:1288PubMedGoogle Scholar
  14. Chantal JD, Krebs S, Kahan A (2001) Chronic recurrent multifocal osteomielitis: five-year outocomes in 14 pediatric cases. Joint Bone Spine 68:242–251Google Scholar
  15. Choi EK, Ha HK, Park SH, Lee SJ, Jung SE, Kim KW, Lee SS (2007) Granulocytic sarcoma of bowel: CT findings. Radiology 243(3):752–759PubMedGoogle Scholar
  16. David Pienkowski et al (2009) Novel three-dimensional MRI technique for study of cartilaginous hip surfaces in Legg–Calvé–Perthes disease. J Orthop Res 27(8):981–988Google Scholar
  17. De Boeck H (2005) Osteomyelitis and septic arthritis in children. Acta Orthop Belg 71:505–515PubMedGoogle Scholar
  18. Demharter J, Bhondorf K, Milch W, Vogt H (1997) Chronic recurrent multifocal osteomyelitis: a radiological and clinical investigation of five cases. Skeletal Radiol 26:579–588PubMedGoogle Scholar
  19. Dillman JR, Hernandez RJ (2009) MRI of Legg–Calve–Perthes disease. AJR 193(5):1394–1407PubMedGoogle Scholar
  20. Dobbs MB, Sheridan JJ, Gordon JE, Corley CL, Szymanski DA, Schoenecker PL (2003) Septic arthritis of the hip in infancy: long-term follow-up. J Pediatr Orthop 23:162–168PubMedGoogle Scholar
  21. Doria AS et al (2008) Legg–Calvé–Perthes disease: multipositional power Doppler sonography of the proximal femoral vascularity. Pediatr Radiol 38(4):392–402PubMedGoogle Scholar
  22. Downey Carmona FJ, Farrington Rueda D (2006) Pyomiositis of hip obturator muscles. Cir Pediátr 19:241–243PubMedGoogle Scholar
  23. Drevelegas A, Pilavaki M, Chourmouzi D (2004) Lipomatous tumors of soft tissue: MR appearance with histological correlation. Eur J Radiol 50:257–267PubMedGoogle Scholar
  24. Dwek JR (2009) The hip: MR imaging of uniquely pediatric disorders. Magn Reson Imaging Clin N Am 17(3):509–520PubMedGoogle Scholar
  25. Fabry G (2010) Clinical practice: the hip from birth to adolescence. Eur J Pediatr 169(2):143–148PubMedGoogle Scholar
  26. Fink LH, Meriweather MW (1979) Primary epidural Ewing’s sarcoma presenting as a lumbar disc protrusion case report. J Neurosurg 51(1):120–123PubMedGoogle Scholar
  27. Forlin E, Milani C (2008) Seqelae of septic arthritis of the hip in children: a new classification and a review of 41 hips. J Pediatr Orthop 28:524–528PubMedGoogle Scholar
  28. Galant J, Martí-Bonmatí L, Sáez F, Soler R, Alcalá-Santaella R, Navarro M (2003) The value of fat-suppressed T2 or STIR sequences in distinguishing lipoma from well-differentiated liposarcoma. Eur Radiol 13:337–343PubMedGoogle Scholar
  29. Gamble JG, Rinsky LA (1986) Chronic recurrent multifocal osteomielitis: distinct clinical entity. J Pediatr Orthop 6:579–584PubMedGoogle Scholar
  30. Garner HW, Kransdorf MJ et al (2009) Benign and malignant soft-tissue tumors: post-treatment MR imaging. RadioGraphics 29:119–134PubMedGoogle Scholar
  31. Girschick HJ, Zimmer C, Klaus G, Darge K, Dick A, Morbach H (2007) Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated? Nat Clin Pract Rheumatol 3(12):733–738PubMedGoogle Scholar
  32. Gutierrez K (2005) Bone and joint infections in children. Pediatr Clin North Am 52:779–794PubMedGoogle Scholar
  33. Ha TV, Kleinman PK, Fraire A, Speavak MR, Nimkin K, Cohen IT et al (1994) MR Imaging of benign fatty tumours in children: report of four cases and review of the literature. Skeletal Radiol 25:361–367Google Scholar
  34. Ha AS, Wells L, Jaramillo D (2008) Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children. Pediatr Radiol 38(11):1195–1200PubMedGoogle Scholar
  35. Haresh KP, Joshi N, Gupta C, Prabhakar R, Sharma DN, Julka PK, Rath GK (2008) Granulocytic sarcoma masquerading as Ewing’s sarcoma: a diagnostic dilemma. J Cancer Res Ther 4(3):137–139PubMedGoogle Scholar
  36. Hernández R, Strouse PJ (2002) Focal pyomyositis of the perisciatic muscles in children. AJR 179:1267–1271PubMedGoogle Scholar
  37. Hernández F, Nistal, Encinas JL (2004) Lipoblastoma: el menos conocido de los tumores adiposos. Cir Pediátr 17:175–178PubMedGoogle Scholar
  38. Herring JA (1994) The treatment of Legg–Calve–Perthes disease. A critical review of the literature. J Bone Joint Surg Am 76:448–458PubMedGoogle Scholar
  39. Hoffer FA, Nikanorov AY, Reddick WE (2000) Accuarcy on MR imaging for detecting epiphyseal extension of osteosarcoma. Pediatr Radiol 30:289–298PubMedGoogle Scholar
  40. Jagodzinski NA, Kanwar R, Graham K, Bache CE (2009) Prospective evaluation of a shortened regimen of treatment for acute osteomyelitis and septic arthritis in children. J Pediatr Orthop 29:518–525PubMedGoogle Scholar
  41. Jansen BR, Hart W, Schreuder O (1993) Discitis in childhood. 12–35-year follow up of 35 patients. Acta Orthop Scand 64:33–36PubMedGoogle Scholar
  42. Jaramillo D (2009) What is the optimal imaging of osteonecrosis, Perthes, and bone infarcts? Pediatr Radiol 39:216–219Google Scholar
  43. Jordanov MI, Block JJ, Gonzalez AL, Green NE (2009) Transarticular spread of Ewing sarcoma mimicking septic arthritis. Pediatr Radiol 39:381–384PubMedGoogle Scholar
  44. Jurik AG (2004) Chronic recurrent multifocal osteomyelitis. Semin Mucsuloskelet Radiol 8(3):243–253Google Scholar
  45. Karmazyn B, Loder RT, Kleiman MB (2007) The role of pelvic MRI in evaluating nonhip sources of infection in children with acute nontraumatic hip pain. J Pediatr Orthop 27:158–164PubMedGoogle Scholar
  46. Kayser R, Mahlfeld K, Greulich M, Grasshoff H (2005) Spondylodiscitis in childhood: results of a long-term study. Spine 30:318–323PubMedGoogle Scholar
  47. Khanna G, Sato TS, Ferguson P (2009) Imaging of chronic recurrent multifocal osteomyelitis. RadioGraphics 29(4):1159–1177PubMedGoogle Scholar
  48. Klimo P Jr, Codd PJ, Grier H, Goumnerova LC (2009) Primary pediatric intraspinal sarcomas. J Neurosurg 4(3):222–229Google Scholar
  49. Krandorf MJ (1995) Benigg soft-tissue tumors in a large referral population: distribution of specific diagnosis by age, sex and location. AJR 164:395–402Google Scholar
  50. Lan TY, Lin DT, Tien HF, Yang RS, Chen CY, Wu K (2009) Prognostic factors of treatment outcomes in patients with granulocytic sarcoma. Acta Haematol 122(4):238–246PubMedGoogle Scholar
  51. Li W, Brock P, Saunders DE (2005) Imaging characteristics of primary cranial Ewing sarcoma. Pediatr Radiol 35(6):612–618PubMedGoogle Scholar
  52. Llorente Otones L, Vázquez Román S (2007) Piomiositis en los niños. No sólo una enfermedad tropical. An Pediatr 67:568–571Google Scholar
  53. Ludwig JA (2008) Ewnig sarcoma: historical perspectives, current state-of-art, and opportunities for targeted therapy in the future. Curr Opin Oncol 20:412–418PubMedGoogle Scholar
  54. Mar WA, Taljanovic MS, Bagatell R, Graham AR, Speer DP, Hunter TB et al (2008) Update on imaging and treatment of Ewing’s sarcoma family tumors: what the radiologist needs to know? J Comput Assist Tomogr 32:108–118PubMedGoogle Scholar
  55. Merlini L et al (2010) Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol 40(3):318–325 PubMedGoogle Scholar
  56. Miller TT (2008) Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology 246:662–674PubMedGoogle Scholar
  57. Mitsionis GI, Manoudis GN, Lykissas MG (2009) Pyomyositis in children. Early diagnosis and treatment. J Pediatr Surg 44:2173–2178PubMedGoogle Scholar
  58. Mortenson W, Edeburn G, Fiers M, Nilsson R (1988) Chronic recurrent multifocal osteomyelitis in children. Acta Radiol 29:565–570Google Scholar
  59. Murphey MD, Robbin MR, McRae GA, Flemming DJ, Temple HT, Kransdorf MJ (1997) The many faces of ostesarcoma. RadioGraphics 17:1205–1231PubMedGoogle Scholar
  60. Murphey MD, Carroll JF, Flemming DJ (2004a) From de archives of the AFIP: benign musculoskeletal lipomatous lesions. RadioGraphics 24:1433–1466PubMedGoogle Scholar
  61. Murphey MD, Jelinek JS, Temple HT, Flemming DJ, Gannon FH (2004b) Imaging of periosteal ostesarcoma: radiologic–pathologic comparison. Radiology 233:129–138PubMedGoogle Scholar
  62. Neiman RS, Barcos M, Berard C et al (1981) Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases. Cancer 48:1426–1437PubMedGoogle Scholar
  63. O’Keeffe F, Lorigan JG, Wallace S (1990) Radiological features of extraskeletal Ewing sarcoma. Br J Radiol 63:456–460PubMedGoogle Scholar
  64. Paydas S, Zorludemir S, Ergin M (2006) Leuk granulocytic sarcoma: 32 cases and review of the literature. Leuk Lymphoma 47(12):2527–2541PubMedGoogle Scholar
  65. Pekala JS, Gururangan S, Provenzale JM, Mukundan S Jr (2006) Central nervous system extraosseous Ewing sarcoma: radiologic manifestations of this newly defined pathologic entity. Am J Neuroradiol 27:580–583PubMedGoogle Scholar
  66. Perlis CS, Collins MH, Honig PJ, Low DW (2000) Forehead lipoblastoma mimicking a hemangioma. Pediatrics 105:123–128PubMedGoogle Scholar
  67. Pileri Sa, Ascani S, Cox MC, Campidelli C, Bacci et al (2007) Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients. Leukemia 21:340–350PubMedGoogle Scholar
  68. Post MJ, Bowen BC, Sze G (1991) Magnetic resonance imaging of spinal infection. Rheum Dis Clin Norh Am 17:773–794Google Scholar
  69. Pretorius ES, Hruban RH, Fishman EK (1996) Tropical pyomyositis:imaging findings and a review of the literature. Skeletal Radiol 25:576–579PubMedGoogle Scholar
  70. Pui M, Fletcher B, Langston J (1994) Granulocytic sarcoma in childhood leukemia: imaging features. Radiology 190:698–702PubMedGoogle Scholar
  71. Quan GM, Slavin JL, Schlicht SM, Smith PJ, Powell GJ, Choong PF (2005) Osteosarcoma near joints: assessment and implications. J Surg Oncol 91:159–166PubMedGoogle Scholar
  72. Ranson M (2009) Imaging of pediatric musculoskeletal infection. Semin Musculoskelet Radiol 13:277–299PubMedGoogle Scholar
  73. Regueras Santos L, Ledesma Benítez I, Regueras Santos L, Ledesma Benítez I, de la Mano LJ Ferrero, Del Río González E, Fernández Castaño MT (2007) Chronic recurrent multifocal osteomyelitis. Our experience. Bol Pediatr 47:136–141Google Scholar
  74. Reiseter T, Nordushus T, Borthne A, Roald B, Naess P, Schistad O (1999) Lipoblastoma: MRI appearances of a rare paediatric soft tissue tumour. Pediatr Radiol 29:542–545PubMedGoogle Scholar
  75. Rodriguez DP, Poussaint TY (2010) Imaging of back pain in children. Am J Neuroradiol 31(5):787–802PubMedGoogle Scholar
  76. Sabourin SM, Jayashankar A, Mullins ME (2008) Imaging of osteosarcoma after irradiation: self-assessment module. AJR 191:S28–S30PubMedGoogle Scholar
  77. Schultz E, Rosenblatt R, Mitsudo S, Weinberg G (1993) Detection of a deep lipoblastoma by MRI and ultrasound. Pediatr Radiol 23:409–410PubMedGoogle Scholar
  78. Shapeero LG, Vanel D, Sundaram M, Ackerman VL, Wuisman P, Bauer TW et al (1994) Periosteal Ewing sarcoma. Radiology 191:825–831PubMedGoogle Scholar
  79. Shin JH, Lee HK, Rhim SC, Cho KJ, Choi CG, Suh DC (2001a) Spinal epidural extraskeletal Ewing sarcoma: MR findings in two cases. AJNR 22:795–798PubMedGoogle Scholar
  80. Shin JH, Lee HK, Rhim SC, Cho K, Choi CG, Suh DC (2001b) Spinal epidural extraskeletal ewing sarcoma: MR findings in two cases. Am J Neuroradiol 22:795–798PubMedGoogle Scholar
  81. Smith AS, Blaser SI (1991) Infectious and inflammatory processes of the spine. Rad Clin Norh Am 29:809–827Google Scholar
  82. Song KS, Ogden JA, Ganey T, Guidera KJ (1997) Contiguous discitis and osteomyelitis in children. J Pediatr Orthop 14:470–477Google Scholar
  83. Song HR et al (2000) Classification of metaphyseal change with magnetic resonance imaging in Legg–Calvé–Perthes disease. J Pediatr Orthop 20(5):557–561PubMedGoogle Scholar
  84. Song J, Letts M, Monson R (2001) Differentiation of psoas muscle abscess from septic arthritis of the hip in children. Clin Orthop Relat Res 391:258–265PubMedGoogle Scholar
  85. Song X, Choi J, Rao C (2008) Primary Ewing sarcoma of lumbar spine with massive intraspinal extension. Pediatr Neurol 38(1):58–60PubMedGoogle Scholar
  86. Spiegel PG, Kengla KW, Isaacson AS, Wilson JC (1972) Intervertebral disc-space inflammation in children. J Bone Joint Surg Am 54:284–296PubMedGoogle Scholar
  87. Stacy GS, Ravinder SM, Peabody TD (2006) Staging of bone tumors: a review with illustrative examples. AJR 186:967–976PubMedGoogle Scholar
  88. Stein-Wexler R (2009) MR imaging of soft tissue masses in children. Radiol Clin North Am 47(6):977–995Google Scholar
  89. Strouse PJ, DiPietro MA, Adler RS (1998) Pediatric hip effusions: evaluation withpower Doppler sonography. Radiology 206:731–735PubMedGoogle Scholar
  90. Suresh S, Saifuddin A (2007) Radiological appereances of appendicular osteosarcoma: a comprehansive pictorial review. Clin Radiol 62:314–323PubMedGoogle Scholar
  91. Tapia Moreno R, Espinosa Fernández MG, Martínez León MI, González Gómez JM, Moreno Pascual P (2009) Spondylodiscitis: diagnosis and medium-long term follow up of 18 cases. An Pediatr (Barc) 71(5):391–399Google Scholar
  92. Tlougan BE, Podjasek JO, O’Haver J, Cordova KB, Nguyen XH, Tee R et al (2009) Chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with associated neutrophilic dermatoses: a report of seven cases and review of the literature. Pediatr Dermatol 26(5):497–505PubMedGoogle Scholar
  93. Uhl M, Saueressig U, Van Buiren M, Kontny U, Niemeyer C, Köhler G et al (2006) Osteosarcoma: preliminary results in vivo assessment of tumor necrosis after chemotherapy with diffusion- and perfusion-weigthed magnetic resonance imaging. Invest Radiol 41:618–623PubMedGoogle Scholar
  94. Vogel G, Gane A, Salai M (2001) Lipoblastoma in an infant’s foot. Isr Med Assoc J 3:540–541PubMedGoogle Scholar
  95. Wenger DR, Bobechko WP, Gilday DL (1978) The spectrum of intervertebral disc-space infection in children. J Bone Joint Surg Am 60:100–108PubMedGoogle Scholar
  96. Wootton-Gorges SL (2009) MR imaging of primary bone tumors and tumor-like conditions in children. MRI Clin North Am 17:469–487Google Scholar
  97. Worch J, Ritter J, Frühwald MC (2008) Presentation of acute promyelocytic leukemia as granulocytic sarcoma. Blood Cancer 50(3):657–660Google Scholar
  98. Zawin JK, Hoffer FA, Rand FF, Teele RL (1993) Joint effusion in children with an irritable hip US diagnosis and aspiration. Radiology 187:459–463PubMedGoogle Scholar
  99. Zwaga T, Boveé JV, Kroon HM (2008) Osteosarcoma of the femur with skip, lymph node, and lung metastases. RadioGraphics 28:277–283PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • María I. Martínez León
    • 1
  • Juan E. Gutiérrez
    • 2
  • Luisa Ceres Ruiz
    • 3
  1. 1.Radiology Department Pediatric Radiology UnitHospital Materno-Infantil del C.H.U. Carlos HayaMálagaSpain
  2. 2.Health Science CenterUniversity of TexasSan AntonioUSA
  3. 3.Radiology Department Pediatric Radiology Unit. ChiefHospital Materno-Infantil del C.H.U. Carlos HayaMálagaSpain

Personalised recommendations