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Received CT scan, medial cortex extremely thinned, defined lucent area, pathological fracture. Meaning?

i have just received CT scan report of my son , I am worried about it , can any body guide me about that. text mentioned in report is as under.
Contrast Enhanced C T Scan: Tibia

Shah Waiz
10 Years-Old-Male

Technique: CT Imaging was performed with appropriately angled contiguous axial slices
with coronal and sagittal reformats.
» A fairly well-defined lucent area is noted in the medial part of distal
metaphysis of tibia. It measures approximately 1.0 x 0.8cm. Mild
surrounding sclerosis is noted. Medial cortex is extremely thinned and
at places appears deficient. No internal calcifications are noted. A
vertical line is seen extending downwards. It crosses the epiphyseal
plate and enters distal epiphyseal ossification center. This lucent line
does not reach articular surface. Mild soft tissue swelling is noted
medial to tibial lesion.
» Ankle joint is normal.
» Tibia talus and talofibular joints are normal.

Date: 9 April 2013
Brig (Retd)
Muhammad Ashraf Farooq

A fairly well-defined lucent area in the medial part of distal metaphysis of
tibia with a lucent line extending distally across the epiphyseal plate into
epiphyseal ossification center (Non ossifying fibroma with undisplaced
pathological fracture).

Asked On : Sun, 14 Apr 2013
Answers:  2 Views:  114
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Radiologist 's  Response

Luscent (lytic) lesions in the bone have several differential diagnosis. In your son's case, this probably represents a small benign lesion of the bone (eg: simple bone cyst, fibrous cortical defect, non ossifying fibroma, etc). None of these requires any specific treatment by themselves.

However, the luscent line reported as a fracture may require treatment and an orthopedic consultation would be indicated. However, generally, fractures extend to the bone surface and are usually associated with some history of fall, etc. This needs to be considered.

Finally, if your son has fever and pain over the bone, a rare possibility of a Brodie's absess (infection) may need consideration.

Answered: Sat, 27 Apr 2013
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Pathologist and Microbiologist Dr. Shailja Puri 's  Response
Hello and welcome to HCM,

The CT report of the lower limb suggests a lesion called non-ossifying fibroma.

Before explaining you the meaning of this term, I would like to give you brief over view.
The ends of long bones (tibia in your case- tibia is one of the long bones of leg) has two parts- epiphysis and metaphysis.
In health, the ends of the bones are cartilaginous. As the child grows the cartilage is replaced by bone.
This process is called ossification.
In some conditions, the ossification does not occur.
Instead the cartilage is replaced by fibrous tissue only without any evidence of ossification.
In the absence of ossification, the bone is soft, appears translucent on X-ray, is not strong enough and breaks easily.

This is exactly what is happening in your son's bone of the leg (tibia).
As the bone is weak it has undergone a pathological fracture (i.e. fracture due to disease of the bone and no due to any kind of trauma).

You need to consult an orthopedician for further management.

Thanks and take care.
Dr Shailja P Wahal
Answered: Sun, 14 Apr 2013
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