Case Presentation

The patient is a 10-year-old girl who has a history of pain in the right wrist for approximately six weeks. She also notes pain in the left knee which has actually somewhat improved. There is no definite history of injury. Radiographs of the wrist showed a worrisome lesion in the distal radius. The patient is referred by Dr. W for orthopedic oncology consultation.

The patient is a product of a normal pregnancy and delivery without complications. She has had no unusual childhood problems. She had febrile seizures as a child which resolved. She has a healthy younger sister. The patient takes no medicines, has no allergies to medicines, has had no surgery and no hospitalizations. She enjoys cheerleading..

Examination of the right upper extremity reveals a little bit of warmth and a little bit of thickening or swelling of the entire wrist. There is no definite mass at the location of the lesion rather there is generalized swelling. However, the range of motion of the wrist and at the elbow is totally normal. There is no lymphadenopathy in the elbow nor in the axilla. Sensation distally and pulsations of the radial artery are normal.

Examination of the left knee reveals full range of motion, no effusion, no tenderness, no mass. There is no warmth or swelling.

Radiographs of the right wrist and on the left knee and an MRI are shown at right.. There is a lytic lesion in the distal radius and adjacent to the distal radial ulnar joint. It reaches up to the growth plate. There is a subtle periosteal reaction. The lesion has very high signal intensity on t2 MRI images.

No lesion is detected in the left knee.

The nature of this lesion is undefined and biopsy is necessary.

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