KINDERRADIOLOGIE ONLINE - view radiology images and radiology cases
Lesen Sie diese Seite auf Deutsch   Read this page in English
The Peer Reviewed Pediatric Radiology Platform on the Web
ISSN: 1942-955X :: Publisher: EduRad ::Editor-In-Chief: Roland Talanow, MD, PhD  
Browse Browse || Search Search || Online Book Systematically Online Book Systematically || Discussion Forum Discussion Forum || News News || Submit a Case Submit a Case || Rules Rules |
Most Interesting Cases Most Interesting Cases || "Most Diligent" Authors "Most Diligent" Authors || Case of the Day Case of the Day || Teaching files Teaching files || Links Links |
Newsletter Newsletter || Start Start || Survey Survey || Your Opinion Your Opinion || My Profile My Profile || CME-Credits CME-Credits |
    Pediatric Radiology News / Ads / Jobs Get the Pediatric Radiology News as RSS feed !
    Send us your news or ads for free
  • Acute side effects of three commonly used gadolinium contrast agents in the pediatric population.... (Br J Radiol)
  • Ultrasound guided placement of the distal catheter in paediatric ventriculoatrial shunts-an appraisa... (Childs Nerv Syst)
  • Fetal MR Imaging of Gastrointestinal Abnormalities.... (Radiographics)
  • CME Kurs: Paediatric Body MRI

  • CME course: Paediatric Body MRI

  • Universitätsklinikum Jena sucht eine Ärztin/einen Arzt in Weiterbildung in Vollzeit

  • Kinderspital Zürich sucht Oberärztin / Oberarzt (100 %)

  • Kinderradiologische Oberärztin / Oberarzt gesucht

  • 2 Stellen in der Kinderradiologie - 1 Assistenzärztin/Assistenzarzt und 1 Oberärztin/Oberarzt in Voll- oder Teilzeit

  • Senior Paediatric Radiologist in Pediatric Radiology section needed

  • Facharzt als Oberärztin / Oberarzt in Sektion Kinderradiologie gesucht

  • Stellenangebot für Assistenzarzt (m/w) zur Facharztausbildung für RADIOLOGIE und/oder KINDERRADIOLOGIE

  • „Fellow“-Stelle zur Weiterbildung in Pädiatrischer Radiologie am Kinderspital Zürich

  • Fellow-Stelle Pädiatrische Neuroradiologie

  • FFF Kinderradiologie - Muskuloskelettale Radiologie im Kindesalter (Fit für den Facharzt)

  • Assistenzarzt für Kinderradiologe gesucht an Universitätsklinikum Schleswig-Holstein, Campus Kiel

  • Turnusarzt (m/w) in Ausbildung zum Facharzt (m/w) für Radiologie

  • Assistenzarzt (m/w) zur Weiterbildung im Schwerpunkt Kinderradiologie

  • Send us your news or ads for free

    Get the Pediatric Radiology News as RSS feed !


    Radiolopolis

    The dynamic Radiology community for education, research and practice


     

    Go to the top of the page   ID: 20070611231443 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

    Bookmark and Share


    | The Authors | Discussion | Write a Comment to this Case |
    | Evaluate this Case | Recommend this Case to a Colleague |
    | Citation | Similar Cases | Similar Cases in the Internet | Images to this Case |
     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are CT-images available for this case. [ CT ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Susanne Oechsle (Klinikum Augsburg/Abteilung Kinderradiologie/Augsburg/Germany), Kurt Vollert (Klinikum Augsburg/Abteilung Kinderradiologie/Augsburg/Germany)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    5 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    Head-Bones  

     
     Pediatric Radiology CasesMost likely etiology:

    neoplastic  

     
     Pediatric Radiology CasesHistory:

    History: Fall on the back of the head 11 days ago. According to mother she developed increased swelling in the left occipital area. There are no neurological deficits.
    Physical examination: Painful palpable left occipital swelling.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Eosinophilic granuloma is the most common and the least severe varient of the Langerhans Cell histiocytosis. Most commonly found in the skull, femur pelvis, ribs and vertebral column. Most monostotic - in 20% of the cases there are multiple masses. Included in the Langerhans Cell Histiocytosis spectrum are the multisystemic forms - Abt-Letterer-Siwe and the Hand-Schüller-Christian illnesses. (I)

    The eitology of the Langerhans Cell Histiocytosis is still unclear. There is a reactice proliferation and/or accumulation of dendritic cells. Assumingly, there is an intercellular communication defect with cytokine-disregulation. As of now, there is no proof of malignancy. (II)

    X-ray morphology is mainly dependent on the stage of the eosinophilic granuloma. Morphology is very diverse, including aggressive as well as latent and active growth patterns possible.
    In the calvarium, there are usually round or oval osteolyses with diameters up to 3 cm. Most are sharply demarcated, as if "punched" through, but in the acute phase there are also unsharp borders possible. In the healing phase, one may find border sclerosis (50%). Bony leftovers in the mid-section of the lesion are seen as button sequesters. In a severe case, there may be a "map-like" picture. (I)  

     
     Pediatric Radiology CasesRadiological findings:


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Ultrasound of the back of the head
    Left occipital identified is a 2 cm, subcutaneous, inhomogeneous and hypoechoic mass lesion. In this area, there is about 12 mm cortical discontinuity. Dura appears deviated inferiorly.
    Color coded Duplex sonography: Increased vascularization in the periphery of the lesion. (Images not shown)
    Ultrasound of the abdomen is unremarkable. (Images not shown)




    CT 1 <- view CT 1

    CT 1: CCT Brain window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    CT 2 <- view CT 2

    CT 2: CCT Bone window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    MRI 1 <- view MRI 1

    MRI 1: MRI of the head - T1 axial
    Left occipital soft tissue mass with marked marginal contrast enhancement, size ca. 1,8 x 2,8 x 1,5 cm. It causes the known defect in the posterior skull and mild dural displacement to the inside.
    There is surrounding leptomeningeal contrast enhancement. There is increased T2 signal and fluid level in the center of the lesion, which represents a trauma related secondary hemorrhage.





    MRI 2 <- view MRI 2

    MRI 2: MRI of the head - T2 axial






    MRI 3 <- view MRI 3

    MRI 3: MRI of the head - T1 axial with contrast






    MRI 4 <- view MRI 4

    MRI 4: MRI of the head - T1 spir coronal (oblique coronal with surface coil) with contrast



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Surgery / Histo  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Lymphoma, solitary bone metastasis of a Neuroblastoma  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Treatment options in Langerhans Cell Histiocytosis: Surgical excision in a solitary skeletal mass (II). Intralesional steroid injection have been tried with questionable results (I). In multisystemic masses and multiple bony lesions, a systemic treatment with corticosteroids, cytostatics and immunosuppressives. Radiation only as a last resort (II).

    The course and prognosis of Langerhans Cell Histiocytosis:
    Monosystemic lesions independent of the treatment have a good prognosis. Multisystemic lesions with organ dysfunction in particularly small children is seen as having a poor prognosis, with possible lethal course. (II)

    Eosinophilic granulomas are mostly seen between the ages of 5 and 10 years. Male gender predominates (makes up of about 60-80% of all Langerhans Cell Histiocytoses). (II)  

     
     Pediatric Radiology CasesComments of the author about the case:

    In this case, there was an unnoticed development of a eosinophilic granuloma in the skull. After trauma, there was hemorrhaging and pain, then the noticed swelling on the left, occipital side.
    Final diagnosis and treatment was accomplished through resection of the mass.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    (I) Bohndorf, Imhof, Fischer:
    Radiologische Diagnostik der Knochen und Gelenke.
    Thieme Verlag 2006. S. 208-209.
    (II) Staatz, Honnef, Piroth, Radkow:
    Kinderradiologie. In: Pareto-Reihe Radiologie.
    Thieme Verlag 2007. S. 257-262.
     

     
     Pediatric Radiology CasesKeywords:

    solitary osteolysis of the skull, langerhans cell histiocytosis, LCH, eosinophilic granuloma, lymphoma, neuroblastoma, swelling of head, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Head-Bones
    or in the region: Head
    or in the tissue/organ: Bones
    or with the etiology: neoplastic
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are CT-images available for this case. [ CT ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Other cases by these authors:

    Search Susanne Oechsle in Medline Susanne Oechsle (1)   
    Search Kurt Vollert in Medline Kurt Vollert (2)   

    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)  
     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     
     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    How interesting was this case for you?
    (10 = most interesting || 1 = less interesting)
     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     




    Discussion >> Write Comment <<



      There are no comments available regarding this case.





     Write a comment to this case (With * marked fields have to be filled)

    Type in this number: 7230

    Name: *

    E-Mail:

    Website:

    Subject: *

    Text: *




     
      Pediatric Radiology Discussion Get the Pediatric Radiology Discussion as RSS feed !
      To the discussion forum
      To the discussion forum

      Get the Pediatric Radiology Discussion as RSS feed !

      © 2001-2016   www.kinderradiologie-online.de
      In cooperation with © Radiolopolis - Radiology Search - Radiology Teacher - PubMed Reader - Annotate - Radiology Lectures & Tutorials - Radiology Boards Preparation - Pediatric Radiology Links - Pediatric Radiology Information - Emergency Radiology - Lung Cancers - USMLE Forums - Cancer Staging Information - Chest Radiology - Radiology Case Report Journal
      For suggestions and questions: information@kinderradiologie-online.de
      Add this site to your favorites (CTRL+D)