Image Quiz
Enlarging Painless Mass in a Four-Year-Old Girl1
Joseph J. King, MD, Rajit Chakravarty, BS, Jean-Pierre DeChadarevian, MD, and Richard D. Lackman, MD*
Department of Orthopaedic Surgery, Pennsylvania Hospital (J.J.K. and R.D.L.), Drexel University College of Medicine (R.C.), and Department of Pathology and Laboratory Medicine, St. Christopher's Hospital for Children (J-P.DeCh.), Philadelphia, Pennsylvania
E-mail address for J. King: jay.king{at}uphs.upenn.edu
A four-year-old girl presented with a nine-month history of an enlarging, painless mass on the anterior aspect of the right lower leg. There was no history of trauma, pain at night, fevers, joint pain, chills, night sweats, or weight loss.
The nontender 1-cm mass was palpable on the anterior aspect of the right lower leg; there were three smaller adjacent palpable nodules that were also nontender. The nodules were mobile, and there was no ulceration. No local associated edema, erythema, or warmth was identified. The patient had a full and painless active range of motion of both the right knee and ankle with normal strength and tone. There was no adenopathy. No motor deficits, sensory deficits, or vascular abnormalities were present. The remainder of the musculoskeletal examination was normal.
The results of the laboratory tests sent to us by the referring physician revealed that the complete blood count, the erythrocyte sedimentation rate, the C-reactive protein level, and the CHEM-7 (sequential multi-channel analysis with computer-7) panel were normal.
A magnetic resonance image without gadolinium had been acquired and also was made available to us by the referring physician.
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An excisional biopsy of the largest pretibial lesion was performed.
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