Pediatric Cortical Desmoid

  • Etiology: Benign self-limited entity that is stress related due to strain or “tugging” on insertion of adductor magnus tendon and medial head of gastrocnemius
  • Imaging Radiograph:
    — Lucent irregular saucer shaped lesion along contour of posteromedial aspect of distal femoral metaphysis which has reactive sclerosis
    — Left greater than right
    — Often but not always bilateral
  • Imaging MRI:
    — T1WI: Low signal intensity
    — T1WI post contrast: Enhances
    — T2WI: High signal intensity
  • Note: This is a do not touch lesion
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:
    — Most common at 10-15 years
    — 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.
Radiograph of pediatric cortical desmoid
AP radiograph of the knee (left) is unremarkable while lateral radiograph (right) shows an irregularity in the contour of the posteromedial aspect of the distal femoral metaphysis that has some reactive sclerosis associated with it.
Radiograph, CT and MRI of pediatric cortical desmoid
AP (above left) and lateral (below left) radiograph of the knee show an irregularity in the contour of the posteromedial aspect of the distal femoral metaphysis. Coronal (above middle) and sagittal (below middle) CT without contrast of the knee show a lucent irregular saucer shaped lesion along the contour of the posteromedial aspect of distal femoral metaphysis which is surrounded by reactive sclerosis. Coronal T1 MRI without contrast of the knee (above right) shows the lesion to have low signal intensity while coronal T2 MRI (below right) shows the lesion to have high signal intensity.