- Discussion:
- most common malignancy of childhood;
- usually affects young children;
- most appear systemically ill;
- dz can mimic
JRA by skeletal and extraskelal manifestations;
- joint disease is usually painful monoarticular (frequently hip) although it can be painful polyarticular
- bone pain is common;
- symptoms may last for months;
- Labs:
- CBC w/ diff does not rule out exclude leukemia;
- bone marrow examination is required for definative diagnosis;
- Radiographs:
- changes appear in many areas of skeletal system but none is pathognomonic;
- skeletal changes are most prevalent in long bones and skull;
- generalized osteoporosis (almost always present)
- in the skull, look for widening of the cranial sutures;
- osteolytic lesions:
- present in two thirds of pts;
- usually in has a diffuse pattern in metaphyseal area;
- lesions may vary in size;
- appearance of new osteolytic lesions, may herald the onset of blastic bone marrow crisis;
- metaphyseal leukemic lines:
- more frequent in the older child;
- occur in metaphysis adjacent to metaphyseal side of epiphseal plate;
- lines are probably not caused by leukemic infiltration;
- lines are a reflection of the metabolic demands on the patient;
- lines represent a disturbance in endochondral bone formation, resulting in abnormally small trabeculae adjacent to epiphysis;
- areas of growth arrest that appear as dense metaphyseal lines which are left behind as the bone continues to grow during remission;
- hence, periods of remission and exacerbation of disease will manifest radiographically w/ alternating dense and lucent areas representing various phases
of activity of the disease;
- Bone Scan: - may be useful in the dx;
Orthopaedic manifestations of leukemia in children.
Skeletal scintigraphy and radiography at onset of acute lymphocytic leukemia in children. Clausen N, Gitze H, Petersen A, et al: Med Pediatr Oncol 1983;11:291.
The Gallium bone scan in acute leukemia. Gates GF: J Nuclear Med 1979;20:854.
An unusual orthopaedic presentation of acute lymphoblastic leukemia.
Hyphenated history: Park-Harris growth arrest lines.
Musculoskeletal Manifestations in Pediatric Acute Leukemia.
