ANSWER for, “What’s The Diagnosis In This Child With Lower Extremity Pain?”
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ANSWERS:1. Can you name the disorder? The disorder shown in these images is EWING'S SARCOMA. Ewing’s Sarcoma is a tumor of the long bones. A long bone is any bone that’s longer than it is wide. During your pediatric board review and on the pediatric boards, look for questions associated with X-rays of the humerus, femur, tibia or fibula. EDUCATIONAL PEARLS FOR YOUR PEDIATRIC BOARD REVIEW:
- Unique to this bone tumor is the possibility of a SOFT TISSUE COMPONENT
- Lesions are painful, so a description of “exercise intolerance” could be from an inability to run
- Shortness of breath or “decreased exercise tolerance” may be due to LUNG METASTASES!
- WHITE ARROW: The white arrow on the image points to ONION SKIN lesions. Look for what looks like a thin extra layer of bone fitting over the bone like a glove. You can also imagine the skin of an onion laying over the bone. If you see this finding on the board, you’re done! Pick Ewing’s Sarcoma and move on.
- RED CIRCLE: The red circle shows a SUNBURST pattern.
- BLUE CIRCLE: The blue circle shows an OSTEOLYTIC lesion.