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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: EDU-063
The Unique Patterns of Classic Metaphyseal Lesion Healing
Purpose or Case Report: The Classic Metaphyseal Lesion (CML) is one of the most specific findings on skeletal surveys indicating child abuse. While there have been multiple studies to show the prevalence and specificity of the CML, very little has been published on the characteristic healing patterns.
The child protective team in our tertiary children’s hospital reviews approximately 6,000 cases from all over the state every year. Many children with a positive skeletal survey will undergo a 14-day follow up survey.
The purpose of this study is to share our experience on patterns of CML healing by comparing the primary survey with its follow up. We have identified a few distinct patterns: Bone formation and sclerosis along the proximal metaphyseal zone, angular deformity of the metaphyseal corner, and subchondral metaphyseal lucencies. These patterns are represented by the accompanying supplemental figures and are described below.
Figure 1 is the 14-day follow up radiograph of an acute distal tibial CML diagnosed on the primary skeletal survey. This radiograph reveals increased sclerosis along the entire length of the metaphyseal zone, a common pattern of CML healing.
Figure 2 is 14-day follow up of a different patient who sustained a CML of the distal tibia. Healing in this case is denoted by the angular deformity and periosteal reaction along the metaphyseal corner.
Figure 3 is a radiograph of the left wrist from a patient’s primary skeletal survey. The subchondral lucency identified along the lateral metaphysis is another common pattern indicative of a healing CML. Interestingly, the 14-day follow up skeletal survey of this patient demonstrated complete resolution of this finding with no signs of prior injury. In several other cases, the metaphysis on follow up exam appeared completely normal.
In summary, knowledge of the radiographic patterns of CML healing can help to identify these lesions as their classic imaging characteristics change. It is also important to recognize that if the first radiograph demonstrates CML, a normal 14-day follow up radiograph does not exclude the diagnosis.
Methods & Materials:
Results:
Conclusions:
The child protective team in our tertiary children’s hospital reviews approximately 6,000 cases from all over the state every year. Many children with a positive skeletal survey will undergo a 14-day follow up survey.
The purpose of this study is to share our experience on patterns of CML healing by comparing the primary survey with its follow up. We have identified a few distinct patterns: Bone formation and sclerosis along the proximal metaphyseal zone, angular deformity of the metaphyseal corner, and subchondral metaphyseal lucencies. These patterns are represented by the accompanying supplemental figures and are described below.
Figure 1 is the 14-day follow up radiograph of an acute distal tibial CML diagnosed on the primary skeletal survey. This radiograph reveals increased sclerosis along the entire length of the metaphyseal zone, a common pattern of CML healing.
Figure 2 is 14-day follow up of a different patient who sustained a CML of the distal tibia. Healing in this case is denoted by the angular deformity and periosteal reaction along the metaphyseal corner.
Figure 3 is a radiograph of the left wrist from a patient’s primary skeletal survey. The subchondral lucency identified along the lateral metaphysis is another common pattern indicative of a healing CML. Interestingly, the 14-day follow up skeletal survey of this patient demonstrated complete resolution of this finding with no signs of prior injury. In several other cases, the metaphysis on follow up exam appeared completely normal.
In summary, knowledge of the radiographic patterns of CML healing can help to identify these lesions as their classic imaging characteristics change. It is also important to recognize that if the first radiograph demonstrates CML, a normal 14-day follow up radiograph does not exclude the diagnosis.
Methods & Materials:
Results:
Conclusions:
More abstracts on this topic:
Child Abuse in Sudan, Africa: Physician Awareness and Knowledge of Child Abuse Incidence, Child Abuse Imaging, and Management
Osman Radya, Ahmed Ilham, Yagoub Shima, Bakeit Mohamed Salih, Mustafa Elrayah, Gabir Abdalla, Marine Megan, Karmazyn Boaz, Gunderman Richard, Heitkamp Darel, Hibbard Roberta, Miller Aaron, Mohammed Alaaeldeen, Satti Satti
Estimating Time Since Injury of Healing Upper and Lower Extremity Fractures in Young ChildrenMesser Diana, Adler Brent, Ruess Lynne, Brink Farah, Xiang Henry, Agnew Amanda
Poster____EDU-063.pdf
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