Langerhans Cell Histiocytosis
HIDEInteractive Transcript
0:01
This was a one-year-old who presented with
0:03
pain along the right lateral orbit.
0:07
The serial imaging here shows a lesion which is
0:12
involving the lateral orbital wall and superior orbital
0:16
wall. It is a bony lesion in a one-year-old.
0:20
Our differential diagnosis for bone lesions in the
0:25
infant and young toddler age includes Langerhans
0:31
cell histiocytosis. Alternatively,
0:35
one might suggest a possible diagnosis of neuroblastoma
0:39
with a primary tumor in the abdomen and secondary
0:42
involvement of the bones of the face and/or
0:45
the skull all comers throughout the world.
0:48
One also might consider involvement of tuberculosis
0:52
affecting the skull and the facial bones.
0:55
In this case,
0:56
the patient shows heterogeneous signal intensity on the
1:02
FLAIR imaging as well as T2-weighted scans
1:06
as well as the post-contrast scans.
1:09
We also note that there appears to be some extraosseous
1:13
involvement with soft tissue enhancement that is
1:16
occurring along the temporalis muscle at the edge of the skull.
1:22
What would be helpful is to have the CT scan in this
1:25
case to identify whether or not this was a punched-out
1:28
lesion that one would expect with Langerhans cell
1:31
histiocytosis. Indeed, that was the case.
1:35
However, we get the sense of that on the axial post-contrast imaging
1:40
and scan where we are losing the edge of the lesion at the bony margin.
1:49
In this age group,
1:50
the best diagnosis is Langerhans cell histiocytosis.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
© 2024 MRI Online. All Rights Reserved.