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Classic metaphyseal lesion

Colin Burke, Thomas Link, Richard J O'Donnell, Soo-Jin Cho, Daria Motamedi
The exact location of origin for giant cell tumors of bone (GCTB) remains controversial, as lesions are not routinely imaged early but rather late when the tumor is large and clinically symptomatic. At the time of diagnosis, GCTB are classically described as lucent, eccentric lesions with nonsclerotic margins, located within the epiphysis to a greater extent than the metaphysis. Here we present a case of a biopsy proven GCTB initially incidentally seen on MRI as a small strictly metaphyseal lesion, which over the course of several years expanded across a closed physis to involve the epiphysis and abut the articular surface/subchondral bone plate...
2016: Case Reports in Radiology
I Delgado Álvarez, I Barber Martínez de la Torre, É Vázquez Méndez
Child abuse or nonaccidental trauma is a major problem worldwide; in Spain, there are about 12,000 victims per year. The detection of specific lesions or findings that are incongruent with the reported mechanism of trauma mean that radiologists are often the physician responsible for sounding the alarm in cases of abuse. The triad consisting of subdural hematoma, metaphyseal fracture, and posterior rib fractures is very characteristic of the battered child syndrome. The finding of acute and chronic lesions in the same patient is highly specific for nonaccidental trauma...
May 2016: Radiología
Jonathan D Thackeray, Jacob Wannemacher, Brent H Adler, Daniel M Lindberg
BACKGROUND: It is widely accepted that the classic metaphyseal lesion (CML) is a traumatic lesion, strongly associated with abuse in infants. Nevertheless, various non-traumatic origins for CMLs continue to be suggested in medical and legal settings. No studies to date systematically describe the association of CMLs with other traumatic injuries. OBJECTIVE: The primary objective of this study is to examine the association of CMLs with other traumatic injuries in a large data set of children evaluated for physical abuse...
July 2016: Pediatric Radiology
Abul Ala Mannan, N Gopendro Singh, Salah Al-Waheeb, Taher N Taher, Emad El Din El Din Mohammed
We describe a rare case of nonossifying fibroma of the mandible in a 15-year-old boy who presented with a left mandibular swelling. Conventional imaging showed an expansile radiolucent lesion involving the angle and the body of the left mandible. The lesion was curetted, and a miniplate was implanted at the excision site. Microscopic examination of the removed specimen revealed a cellular lesion characterized by a proliferation of uniform spindle-shaped cells in a vague but prominent storiform pattern, which represented the classic appearance of nonossifying fibroma...
June 2015: Ear, Nose, & Throat Journal
Angela Thompson, Gina Bertocci, Kim Kaczor, Craig Smalley, Mary Clyde Pierce
OBJECTIVE: The classic metaphyseal lesion is highly associated with abuse in infants. Classic metaphyseal lesions, also referred to as corner or bucket-handle fractures, are fractures through the metaphyseal region of the long bones near the growth plate. Knowledge of the biomechanics and mechanisms necessary to produce a classic metaphyseal lesion may provide insight into the injury causation associated with this unique fracture type. Thus, the purpose of this study was to investigate loading conditions necessary to create a classic metaphyseal lesion using an immature porcine model...
May 2015: AJR. American Journal of Roentgenology
Jeannette M Perez-Rossello, Anna G McDonald, Andrew E Rosenberg, Andy Tsai, Paul K Kleinman
PURPOSE: To determine if rickets is present in cases of infant homicide with classic metaphyseal lesions (CMLs) and other skeletal injuries. MATERIALS AND METHODS: This study was exempt from the institutional human subjects board review because all infants were deceased. An archival review (1984-2012) was performed of the radiologic and histopathologic findings of 46 consecutive infant fatalities referred from the state medical examiner's office for the evaluation of possible child abuse...
June 2015: Radiology
E Mascard, A Gomez-Brouchet, K Lambot
Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion...
February 2015: Orthopaedics & Traumatology, Surgery & Research: OTSR
Charis Kepron, Michael S Pollanen
PURPOSE: The bone changes of vitamin D deficiency rickets have been invoked as an alternate explanation for child-abuse related fractures identified through medical imaging. The lack of modern histopathologic comparisons between these two entities limits the abilities of the forensic pathologist to address this differential diagnosis, both in their autopsy reports and on the witness stand. METHODS: We report a comparison of the histologic appearance of the bones in a two year old child with vitamin D deficiency rickets with fractures occurring in three young children with child abuse...
March 2015: Forensic Science, Medicine, and Pathology
Ignasi Barber, Paul K Kleinman
Skeletal injuries are commonly encountered in infants and young children with abusive head trauma. Although certain patterns of intracranial injury suggest abuse, none are diagnostic. Therefore demonstration of associated unsuspected skeletal injuries has important implications, particularly when highly specific fractures are present. Skull fractures are commonly associated with intracranial injury, but no fracture pattern is indicative of physical abuse. Other skeletal injuries including classic metaphyseal lesions and rib, spine and scapular fractures are strong predictors of abusive head trauma in infants with intracranial injury...
December 2014: Pediatric Radiology
Kimberly E Fagen, Eglal Shalaby-Rana, Allison M Jackson
BACKGROUND: It is estimated that inflicted burn injuries in physically abused children occur with a prevalence of approximately 6-20%. Identification of burns of a nonaccidental nature is oftentimes difficult. Underlying skeletal injuries in abusive environments are often overshadowed by the acute burn injury. OBJECTIVE: We assessed the prevalence of inflicted burns and the frequency of associated skeletal injuries in a population from a large children's hospital...
March 2015: Pediatric Radiology
David Ayoub, Marvin Miller, Charles Hyman
No abstract text is available yet for this article.
August 2014: AJR. American Journal of Roentgenology
Stephen D Brown, Sabah Serveas, Laura L Hayes
No abstract text is available yet for this article.
August 2014: AJR. American Journal of Roentgenology
Andy Tsai, Anna G McDonald, Andrew E Rosenberg, Rajiv Gupta, Paul K Kleinman
No abstract text is available yet for this article.
September 2014: Pediatric Radiology
Paul K Kleinman
No abstract text is available yet for this article.
June 2014: AJR. American Journal of Roentgenology
Andy Tsai, Anna G McDonald, Andrew E Rosenberg, Rajiv Gupta, Paul K Kleinman
BACKGROUND: The classic metaphyseal lesion (CML) is a common high specificity indicator of infant abuse and its imaging features have been correlated histopathologically in infant fatalities. OBJECTIVE: High-resolution CT imaging and histologic correlates were employed to (1) characterize the normal infant anatomy surrounding the chondro-osseous junction, and (2) confirm the 3-D model of the CML previously inferred from planar radiography and histopathology. MATERIALS AND METHODS: Long bone specimens from 5 fatally abused infants, whose skeletal survey showed definite or suspected CMLs, were studied postmortem...
February 2014: Pediatric Radiology
Beverly P Wood
No abstract text is available yet for this article.
January 2014: AJR. American Journal of Roentgenology
David M Ayoub, Charles Hyman, Marta Cohen, Marvin Miller
OBJECTIVE: The purpose of this study was to review the hypothesis that classic metaphyseal lesions represent traumatic changes in abused infants and compare these lesions with healing rickets. MATERIALS AND METHODS: Using a PubMed search, a multidisciplinary team reviewed studies that reported the histopathologic correlation of classic metaphyseal lesions. Selective studies of growth plate injury and rickets were cross-referenced. RESULTS: Nine identified classic metaphyseal lesion studies were performed by the same principal investigator...
January 2014: AJR. American Journal of Roentgenology
Andy Tsai, Anna G McDonald, Andrew E Rosenberg, Catherine Stamoulis, Paul K Kleinman
BACKGROUND: Studies have shown that the fracture plane of the classic metaphyseal lesion (CML) of infant abuse occurs in the region of the primary spongiosa, encompassing a radiodense fracture fragment customarily referred to as the "zone of provisional calcification" or ZPC. However, the zone of provisional calcification is defined differently in the pathology and the imaging literature, potentially impeding efforts to understand the fundamental morphological features of the classic metaphyseal lesion...
December 2013: Pediatric Radiology
Marion R Roderick, Athimalaipet V Ramanan
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease occurring primarily in children and adolescents. Episodes of systemic inflammation occur due to immune dysregulation without autoantibodies, pathogens or antigen-specific T cells. CRMO is characterised by the insidious onset of pain with swelling and tenderness over the affected bones. Clavicular involvement was the classical description; however, the metaphyses and epiphyses of long bones are frequently affected. Lesions may occur in any bone, including vertebrae...
2013: Advances in Experimental Medicine and Biology
Jordi Font Segura, Sergi Barrera-Ochoa, Albert Gargallo-Margarit, Eva Correa-Vázquez, Anna Isart-Torruella, Xavier Mir Bullo
Osteoid osteoma (OO) is a small and painful benign osteoblastic tumour located preferentially in the shaft of long bones near the metaphyseal junctions, with a predilection for the lower limbs. Juxta- and intra-articular OOs are rare and even though hip, elbow, and talus are the most commonly reported locations, they may be found in any joint accounting for approximately 13% of all osteoid osteomas. There is usually a significant time delay between symptom initiation and diagnosis when the lesion is present in an uncommon location due to the diagnostic challenge it presents due to the lack of classical clinical signs and/or radiographic features found in the extra-articular lesions...
2013: Case Reports in Medicine
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