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MR Imaging of Sports-Related Pseudotumor in Children

Mid Femoral Diaphyseal Periostitis at Insertion Site of Adductor Musculature

S. E. Anderson1, J. O. Johnston2, R. O'Donnell2 and L. S. Steinbach3

1 Department of Diagnostic Radiology, University Hospital of Bern, Inselspital, 3010 Bern, Switzerland.
2 Department of Orthopedic Surgery, University of California, San Francisco, CA 94143.
3 Department of Radiology, University of California, San Francisco, CA 94143.



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  		Fig. 1A. —Patient 1: 15-year-old male marathon runner and wrestler. Conventional radiograph reveals smooth periosteal reaction (arrows) at junction of mid and distal thirds of right femur.

 


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  		Fig. 1B. —Patient 1: 15-year-old male marathon runner and wrestler. Bone scintigraph shows early focal uptake (arrows) at same location as seen on A.

 


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  		Fig. 1C. —Patient 1: 15-year-old male marathon runner and wrestler. Coronal T1-weighted MR image (C) (TR/TE, 533/18) and coronal T2-weighted fat-saturated MR image (D) (4000/120) reveal marked diffuse bone marrow edema (arrows, D) and absence of bone or soft-tissue mass.

 


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  		Fig. 1D. —Patient 1: 15-year-old male marathon runner and wrestler. Coronal T1-weighted MR image (C) (TR/TE, 533/18) and coronal T2-weighted fat-saturated MR image (D) (4000/120) reveal marked diffuse bone marrow edema (arrows, D) and absence of bone or soft-tissue mass.

 


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  		Fig. 1E. —Patient 1: 15-year-old male marathon runner and wrestler. Axial T2-weighted fat-saturated MR image (fast spin-echo; 2000/120) shows posteromedial periosteal reaction and muscle—bone interface edema at junction of vastus intermedius and vastus medialis insertion (asterisk).

 


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  		Fig. 2A. —Patient 2: 3-year-old girl injured doing monkey-bar splits. Oblique sagittal T2-weighted fat-saturated MR image of left femur shows diffuse bone marrow edema (arrows).

 


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  		Fig. 2B. —Patient 2: 3-year-old girl injured doing monkey-bar splits. More anteriorly located oblique sagittal T2-weighted fat-saturated MR image reveals focal fluid (arrows) at anteromedial aspect of proximal femur at site of partial avulsion of adductor muscle group.

 


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  		Fig. 2C. —Patient 2: 3-year-old girl injured doing monkey-bar splits. Axial T2-weighted fat-saturated MR image (fast spin-echo; TR/TE, 4000/102) reveals edema at muscle—bone interface (arrows).

 


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  		Fig. 3A. —Patient 3: 15-year-old male gymnast who had been exercising adductor muscles several weeks before images were obtained. Conventional radiograph shows subtle periosteal new bone formation (arrow).

 


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  		Fig. 3B. —Patient 3: 15-year-old male gymnast who had been exercising adductor muscles several weeks before images were obtained. Corresponding delayed phase of bone scan reveals focal uptake at site of periosteal reaction.

 

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