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Testicular Leukemia Recurrence
Joseph Junewick, MD FACR
over 7 years ago
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Case History

13 year old male very active in sports with knee pain who had been referred for physical therapy.

Case Detail

Anatomy: Musculoskeletal
Heather Borders, MD
Diagnostic Category: Trauma
Created: over 8 years ago
Updated: over 8 years ago
Tags: PEDS
Modality/Study Types: MRI
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Reveal Findings

Abnormal physeal widening involving the distal femur and proximal tibia with a normal fibular physis. There was a cartilaginous rest in the proximal tibial metaphysis.

Reveal Discussion

The differential for physeal widening includes metabolic disorders such as rickets, metaphyseal dysplasia, chronic trauma, leukemia. The diagnosis of a stress injury should be considered in a patient who is athletic without a metabolic disorder or deformity.

Newly formed bone immediately adjacent to the metaphysis is sensitive to trauma. There is disruption of microvasculature and disruption of endochondral bone formation with the resultant physeal widening as cartilage is not properly mineralized.

Imaging findings include physeal widening, metaphyseal cartilage rests and metaphyseal signal change. This is important to recognize as patients with these physeal changes should not undergo physical rehab (what was prescribed for this patient). Treatment is rest.

Reveal Diagnosis

Physeal stress injury

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