The Case of the Painful Leg . David Mansoor Radiology, Feb 2004. HPI. 12 y.o. male with 1 year history left thigh pain Acute onset 1 year ago and has persisted since No inciting event “pressure” sensation on inner part of left thigh Denies sharp or shooting sensations
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Radiology, Feb 2004
Aspirin 225mg bid
Left proximal medial thigh tenderness
No limitations in ROM
No pain with movement
Normal gaitPMH PE
Trauma (muscle bruise, fracture, etc)
Bone tumor (malignant—osteosarcoma, Ewing’s tumor; benign—osteoblastoma, osteoid osteoma; metastatic)
Infection and inflammation (osteomylitis, myositis, TB, etc)
Other (slipped capital femoral epiphysis, Legg Calve Perthe’s Dz, etc)DDx of Leg Pain in Children
CTWorkup (you choose)…
Occasionally regresses spontaneously
May induce scoliosis if spinal column is involved
Pain, pain, pain
Skeletal bone pain
Worsens at night
Worsens with EtOH
Relieved by aspirinMortality/Morbidity
Now considered to be safe, minimally invasive, and cost-effective treatment
Radiologists role is not only to diagnose but also treat!!
Training is offered to musculoskeletal & interventional fellowsRadiofrequency Thermal Ablation: CT Guided
Rosenthal D, Rosenberg A, Springfield D. Ablation of Osteoid Osteomas with a Percutaneously Placed Electrode: A New Procedure.
Radiology. 1992; 183:29-33
Complications during needle passage: bleeding and nerve injury
Complications also include soft-tissue burns, infection, skin necrosis in superficially located tumorsRTA: Contraindications and Complications
Pinto et al. Technical Considerations in CT-guided Radiofrequency Thermal Ablation of Osteoid Osteoma: Tricks of the Trade.
American Journal of Radiology. December 2002.
Most common hip disorder in teens, occurs during growth spurt
boys>girls, usually overweight
Fracture through growth plate of proximal femur with relative slip of the epiphysis (femoral head “slips” off neck of femur)*
Persistent pain with limp
Legg Calve Perthe’s Disease
Idiopathic avascular necrosis of the femoral head
Most common in boys 4-10
Persistent pain with limp, limited range of motion, atrophy of upper thigh muscles