Case report 841

Abstract

Fig. 1. Anteroposterior radiograph of the proximal left femur shows lytic lesions (arrows), some with surrounding sclerosis, and mildly expansile cortical lesions in the subtrochanteric region medially (open arrow) Fig. 2A, B. Coronal Tl-weighted (A) and T2-weighted fat saturated (B) spin-echo magnetic resonance images, obtained 1 day after the radiographs, show extensive lesions in the marrow space of the subtrochanteric region and the femoral neck. The expansile lesions in the medial cortex are well seen (arrow), as are also linear and serpiginous lesions in the femoral neck, suggesting a vascular component Fig. 3. Anterior view 99myc bone scan of pelvis and proximal femora, obtained the same day as the radiographs, demonstrates no evidence of increased uptake at the lesions in the proximal left femur. There is slight asymmetry between left and right, which is attributed to patient positioning Clinical informationA previously healthy 8-year-old girl was referred for evaluation of a lesion of the left femur. She had never complained of any symptoms, but for approximately the past 9 months her parents had noticed occasional left-sided limping of variable intensity. Soon after the limp presented, the patient had been brought to the hospital for examination. The patient could not localize any site of pain causing her limp, and radiographs of the foot and ankle were normal. Due to persistent symptoms, another radiographic examination of the left hip was carried out several months later and demonstrated a lytic lesion in the proximal femur (Fig: 1). The patient was referred to our medical center for further evaluation. On examination here, an antalgic gait was noted, as well as a mild decrease in circumference of both thigh and calf of the left leg. A 1-cm leg length discrepancy was noted, the left leg being shorter. All joints of the lower extremities had full and symmetric range of motion, and there was no evidence of pain or tenderness. A magnetic resonance (MR) examination of the proximal femora (Fig. 2) had recently been performed on a 1.5-T system, and a b o n e scan (Fig.

Haemolymphangiomas of the lower extremities

“…One hundred and eightysix patients were examined and 191 haemangiomas were found with the anatomical distribution of 48% in the head and neck, 42% in the extremities and 10% in internal locations, but only three were found to be histologically haemolymphangiomas [2]. Another report referred a haemolymphangioma of the femur in an 8-year-old girl who had been treated by surgical excision [3]. Haemolymphangiomas are considered to be developmental lymphatic malformations consisting of vessels with thin walls and a supporting network of connective tissue.…”

“…Very few cases of haemolymphangiomas of the extremities have been reported [2,3]. One hundred and eightysix patients were examined and 191 haemangiomas were found with the anatomical distribution of 48% in the head and neck, 42% in the extremities and 10% in internal locations, but only three were found to be histologically haemolymphangiomas [2].…”

“…The incidence of haemolymphangiomas varies from 1.2 to 2.8 per 1000 newborns [2] with both the sexes equally affected and only 6.5% of those being present on the lower extremities [3][4][5][6][7].…”

Cystic angiomatosis, a heterogeneous condition

“…This feature is very rare in CA, but the MRI scan was otherwise typical of this condition. To our knowledge, only one other author has described an isolated femoral neck cortical lytic cyst [33] in a patient with histological features of a biopsied lesion fully consistent with CA (cystic vascular spaces lined with a single layer of endothelial cells). The sclerotic rim may also be absent, especially in skull cysts [27] …”

“…[ 24 33 34–36 ] Indeed, T2-weighted sequences almost always display a strong signal because of the liquid content of the cysts. The T1-weighted sequence signal obtained depends on cyst content: it may be weak (cysts containing serum), or strong (cysts containing blood) [37] .…”