Pediatric Bone Metastasis

  • Etiology: Most commonly neuroblastoma, rhabdomyosarcoma, primary bone tumors (osteosarcoma, Ewing sarcoma), leukemia, lymphoma
  • Imaging Radiograph:
    — Lytic lesions when due to solid tumors
    — Loss of vertebral body height in leukemia
  • DDX:
  • Complications: Pathologic fracture
  • Treatment:
  • Clinical: May be painful

Radiology Cases of Bone Metastases

Radiology Cases of Neuroblastoma Bone Metastases

Radiograph of neuroblastoma bone metastases to the femur
AP radiograph of the femurs shows a mottled appearance to both femurs with multiple lytic lesions noted in the femurs with associated periosteal reaction, more prominent on the left than the right.
Radiograph of bone metastases from neuroblastoma
AP radiographs of the humerus (above) and radius and ulna (below) show lesions involving the proximal humeral diaphysis, entire radial diaphysis and proximal ulna diaphysis all of which are lytic in appearance and having a wide zone of transition and associated faint periosteal reaction.
CT of adrenal neuroblastoma with bone metastases
Coronal (left) and axial (above right) CT with contrast of the abdomen show a large low density faintly calcified mass arising from the right adrenal gland. Axial image of the pelvis in bone windows (below) shows multiple lytic bone lesions throughout the iliac wings and sacrum.
US and CT of adrenal neuroblastoma
Sagittal US of the left kidney (above left) shows a large, solid, hyperechoic mass superior to the left kidney. Axial CT with contrast of the abdomen (above right) shows an ill-defined solid mass in the region of the left adrenal gland, which (below right) crosses the midline and encases the mesenteric vasculature. Axial CT without contrast of the brain (below left) shows a lytic lesion in the right mandible.
CT of neuroblastoma with orbital metastasis
Axial CT without contrast of the abdomen (above) shows a large mass that has faint calcifications within it that fills the entire left upper quadrant of the abdomen. Axial CT without (lower left) and with (lower right) contrast of the orbit shows a round soft tissue mass around the right pterygoid plate that enhances strongly with contrast.

Radiology Cases of Leukemia Bone Metastases

Radiograph of leukemia of the spine
Lateral radiograph of the thoracic spine shows diffuse osteopenia in the vertebral bodies with loss of height (vertebra plana) in all of the vertebral bodies.
Radiograph of acute lymphoblastic leukemia in the spine
Lateral radiographs at presentation of the thoracic (left) and lumbar (middle) spine show diffuse osteopenia and loss of vertebral body height throughout the spine while lateral radiograph obtained a decade later of the lumbar spine (right) shows a faint bone within bone appearance of the vertebral bodies.