0:01

So here is a pediatric patient with anterior shin pain.

0:08

We have a fat-suppressed fluid sequence...

0:12

a fat-suppressed fluid sensitive sequence on the left,

0:15

similarly in the axial plane and a coronal T1 sequence here.

0:20

When I see an anterior tibia lesion that looks like this,

0:23

that has sort of scalloped margins that's located predominantly in the cortex

0:29

and in the surrounding marrow, centered in the tibia,

0:32

there are two things I consider.

0:34

I consider adamantinoma,

0:36

which is a malignant diagnosis, and osteofibrous dysplasia.

0:41

What this is.

0:42

Adamantinoma, since it is malignant,

0:44

tends to be a lot more aggressive in its appearance.

0:46

So you'd see more soft tissue edema, more bony destruction.

0:50

This looks like it's just sort of growing in the bone, having scalloped margins.

0:54

It's not really doing any kind of infiltration.

0:58

Right? Look at the margins here.

0:59

You can see the scalloped very, very well.

1:02

There's some expansion, but absolutely no edema in the surrounding soft tissues.

1:07

No edema over here.

1:08

Doesn't have any relationship to neurovascular bundle.

1:12

It looks like a benign lesion.

1:14

When I see something like this, I usually recommend a plain radiograph

1:18

because it has a very characteristic appearance.

1:20

I don't have one to share with you on this case because they didn't get one.

1:23

I felt pretty confident that this was

1:25

the diagnosis of osteofibrous dysplasia, and that's what this ended up being.

1:29

But look at the margins. That's the key thing.

1:32

Looking at the margins...

1:34

Don't worry about what's happening

1:35

in the marrow, because it can elicit a little bit of edema in the marrow,

1:38

but predominantly at the cortex and in the soft tissues,

1:41

it should be very, very clean.

1:43

There should be no periosteal reaction also.

1:45

And the scalloped, location.

1:47

Two things,

1:49

adamantinoma, osteofibrous dysplasia.

1:52

This is osteofibrous dysplasia.