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|01-23-2009, 07:11 AM||post no: 1|
Acute Lymphocytic Leukemia (ALL) Pictures - Pediatric cases
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Clinical History: 3-year-old male who is brought in by his parents because of his refusal to walk.
Findings: Two-view films of both extremities were obtained. There are epiphyseal bony changes seen. Both sclerotic and lucent areas are identified particularly about the knee. This is more obvious in the distal left femoral metaphysis than elsewhere.
In the proximal left tibial metaphysis there is subchondral bone collapse suggesting fracture. There is associated soft tissue edema when compared to the right side.
In addition, there is a very subtle lucency in the anterior distal left tibial metaphysis which may represent fracture. No soft tissue edema is seen. Mild left metatarus adductus consistent with patient's history of left clubfoot. There is discrepancy in amount of muscular mass in the left calf compared to the right presumed related to clubfoot.
Diagnosis: Acute lymphocytic leukemia (ALL.)
Discussion: ALL is the most common malignancy of childhood. It is abnormal lymphoid cells that initially proliferate in the bone marrow before spreading to the peripheral blood, spleen, lymph nodes and eventually any tissue. There is usually a defect in the white blood cell maturation beyond the lymphoblastic stage. The etiology is not known, however genetic and environmental factors are said to be involved. Incidence is 13 per 100,000/year (includes all leukemias) and is usually higher in boys. Children present with nonspecific symptoms which may mimic infection or inflammation, fever, elevated ESR, hepatosplenomegaly, and occasionally lymphadenopathy. The peak onset age is 4 years old.
Radiographic skeletal changes are seen in 50-70% of children with leukemia and include:
Resnick D, et al. Myeloproliferative Disorders, Resnick Bone and
Joint Imaging, 2nd Ed. W.B. Saunders pg:625-7.
Ajay S. Sufi, M.D.
Kimberly E. Applegate, M.D.
|(all), acute, cases, leukemia, lymphocytic, pediatric, pictures|
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