Pediatric Osteochondromatosis

  • Etiology: Piece of growth plate separates and lays down cartilage off of normal axis of development
  • Imaging Radiograph: Multiple osteochondromas
  • Imaging Radiograph signs of malignant transformation:
    — Growth of exostosis in already mature skeleton
    — Cartilage cap greater than 3 centimeters thick prior to skeletal maturity
    — New cortical irregularity
    — Osseous destruction
  • DDX:
  • Complications: Malignant transformation to chondrosarcoma in 3-5%
  • Treatment: Surgical if symptomatic
  • Clinical: Pain is a concerning sign for malignant transformation

Radiology Cases of Osteochondromatosis

Radiograph of multiple osteochondromas of the knee
AP radiograph of the knees shows bilateral lesions arising from the medial aspect of each tibial metaphysis, with a bony stalk growing away from the metaphysis with a lytic lesion growing at the tip of each stalk with a narrow zone of transition and no associated periosteal reaction.
Radiograph of osteochondromatosis
AP (left) and lateral (right) radiographs of the leg show multiple lesions arising from the distal femoral and proximal tibial metaphyses. Some of the lesions are sessile in appearance while some are pedunculated in appearance. Each lesion has a bony stalk growing away from the metaphysis with a lucent lesion growing at the tip of each stalk with a narrow zone of transition and no associated periosteal reaction.