Pretibial lumps in childhood: a spectrum of abnormalities.

Congress:

ECR 2020

Poster Number:

C-08057

Type:

Educational Exhibit

Keywords:

Paediatric, Extremities, Musculoskeletal soft tissue, Soft tissues / Skin, MR, Ultrasound, Education, Inflammation, Lymphoma, Neoplasia, Not applicable

Authors:

E. I. R. Parks¹, E. A. King², J. Yeomans², R. W. Thomas², A. EVANS²; ¹Cardiff /UK, ²Cardiff/UK

DOI:

10.26044/ecr2020/C-08057

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-08057

Fig. 3: Ultrasound image demonstrating fat necrosis

Fig. 4: Ultrasound image demonstrating fat necrosis

Fig. 5: Longitudinal Ultrasound image showing herniation of muscle and fatty tissue

Fig. 6: Axial Ultrasound image showing herniation of muscle and fatty tissue

Learning objectives

·Review imaging of a series of paediatric cases presenting with a pretibial lump. ·Highlight radiological features which may aid diagnosis, with focus on ultrasound and MRI.

Background

The pretibial area is a frequent site of injury in childhood, with swelling commonly seen consequent to soft tissue haematoma. In the absence of a convincing history of trauma or when a suspected haematoma fails to resolve, the presence of a new or persisting lump raisesthe possibilityof more concerning pathology, requiring further evaluation and imaging.

Findings and procedure details

We present a series of paediatric cases attending our radiology institution over several years with history of pretibial swelling, not felt to be solely secondary to trauma. Whilst clinical evaluation, ultrasound and plain film alone were sufficient to make a firm diagnosis in some cases, the remainder required further imaging. MRI was useful in narrowing the differential diagnosis and assessing underlying bony involvement, however histological evaluation was required to confirm the diagnosis in many cases. The majority of lesions were soft tissue in origin; pathologies...

Conclusion

Paediatric patients presenting with pretibial lumps without clear history of trauma, lumps that do not resolve, or those that are increasing in size require further evaluation. Clinical assessment, along with plain film imaging and ultrasound may allow definitive diagnosis, however MRI and/or biopsy may be required for conclusive diagnosis.

Personal information and conflict of interest

E. I. R. Parks; Cardiff/UK - nothing to disclose J. Yeomans; Cardiff/UK - nothing to disclose E. A. King; Cardiff/UK - nothing to disclose R. W. Thomas; Cardiff/UK - nothing to disclose A. Evans; Cardiff/UK - nothing to disclose

References

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