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Classic Metaphyseal Fracture of Abuse
Joseph Junewick, MD FACR
over 6 years ago
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Case History


2 year old male with developmental delay and hypotonia.


Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Malignant
Created: over 6 years ago
Updated: over 5 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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Case Images


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Reveal Findings

MR – Sagittal and axial postgadolinium T1 and axial diffusion and ADC images of the brain and sagittal T2 of the spine show a large intra-fourth ventricular enhancing hypercellular mass with numerous extraaxial metastatic lesions in the supratentorial, basal cistern and intraspinal regions.

Reveal Discussion

Medulloblastoma is the most common primary tumor of the posterior fossa in children, usually occurring before age 10 and more often in males. The strong predilection of the tumor for the vermis and fourth ventricular obstruction lead to early onset of symptoms. Macroscopic subarachnoid seeding occurs in nearly 33% of all patients at the time of initial diagnosis. The spinal cord is the most common site of spread. Supratentorial involvement frequently involves the frontal and subfrontal regions but can be found anywhere CSF is present. Medulloblastoma metastasis to the peritoneum can occur as a result of ventriculoperitoneal shunting. Surgical resection and reestablishment of normal CSF flow remain the primnary means of treatment of medulloblastoma but he role of adjuvant chemotherapy in the treatment of childhood medulloblastoma is increasing. Medulloblastoma is very radiosensitive.

Reveal Diagnosis

Medulloblastoma with CNS Dissemination

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