Pediatric Cortical Desmoid

  • Etiology: benign self-limited entity, stress related due to “tugging” on insertion of adductor magnus tendon / medial head of gastrocnemius
  • Radiograph: lucent irregular saucer shaped lesion along contour of posteromedial aspect of distal femoral metaphysis which has reactive sclerosis
  • MRI: low signal intensity of T1WI, high signal intensity on T2WI, enhances with contrast
  • Clinical: Don’t touch lesion, most common at 10-15 years, often but not always bilateral, left > right, consider using the term “tug lesion” or “avulsive irregularity” rather than “cortical desmoid”, usually asymptomatic and found incidentally

Radiology Cases of Cortical Desmoid

Radiograph of cortical desmoid
AP (left) and lateral (right) radiographs of the knee show an irregularity in the contour of the posteromedial aspect of the distal femoral metaphysis.