Cortical desmoid
Updates to Article Attributes
A cortical desmoid (also known as cortical avulsive injury) is a benign self limiting entity. This is a classic 'don't touch' lesion, and should not be confused with an agressive cortical / periosteal process (e.g. osteosarcoma).
Epidemiology
It typically presents in adolescents (10-15 years of age). There may be a male predilection.
Clinical presentation
Patients are usually asymptomatic and it is discovered incidentally. Occasionally pain may be present.
Pathology
It is related to repetitive stress at the attachment of the adductor magnus aponeurosis at the medial posterior aspect of the distal femoral metaphysis.
Location
It is seen at the posterior aspect of the distal femur. Can be bilateral in ~ 1/3 of cases.
Radiographic features
Plain film
Typically shows a saucer-shaped radiolucent cortical irregularity involving posteromedial aspect of the distal femoral metaphysis at the attachment of the adductor magnus tendon. The lesion lacks an outer margin.
MRI
Defines anatomy much better and is seen as a cortically based lesion in the expected location (i.e. posteromedial distal femoral metaphysis).
- T1 - low signal 4
- T2 - high signal 4 a surrounding low signal rim may be present.
- T1 C+ (Gd) - most show enhancement 3
Bone scan
There is an abnormal increase in activity because of the chronic stress/traumatic origin of this lesion.
Cortical desmoid is one of the skeletal “Don’t touch” lesions.
Differential diagnosis
Imaging diferential considerations include
-<p>A<strong> cortical desmoid</strong> (also known as <strong>cortical avulsive injury</strong>) is a benign self limiting entity. This is a classic 'don't touch' lesion, and should not be confused with an agressive cortical / periosteal process (e.g. <a href="/articles/parosteal_osteosarcoma">osteosarcoma</a>). </p><h4>Epidemiology</h4><p>It typically presents in adolescents (10-15 years of age). There may be a male predilection. </p><h4>Clinical presentation</h4><p>Patients are usually asymptomatic and it is discovered incidentally. Occasionally pain may be present.</p><h4>Pathology</h4><p>It is related to repetitive stress at the attachment of the adductor magnus aponeurosis at the medial posterior aspect of the distal femoral metaphysis.</p><h5>Location</h5><p>It is seen at the posterior aspect of the distal femur. Can be bilateral in ~ 1/3 of cases.</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Typically shows a saucer-shaped radiolucent cortical irregularity involving posteromedial aspect of the distal femoral metaphysis at the attachment of the adductor magnus tendon. The lesion lacks an outer margin.</p><h5>MRI</h5><p>Defines anatomy much better and is seen as a cortically based lesion in the expected location (i.e. posteromedial distal femoral metaphysis).</p><ul>- +<p>A<strong> cortical desmoid</strong> (also known as <strong>cortical avulsive injury</strong>) is a benign self limiting entity. This is a classic 'don't touch' lesion, and should not be confused with an agressive cortical / periosteal process (e.g. <a href="/articles/parosteal-osteosarcoma-1">osteosarcoma</a>). </p><h4>Epidemiology</h4><p>It typically presents in adolescents (10-15 years of age). There may be a male predilection. </p><h4>Clinical presentation</h4><p>Patients are usually asymptomatic and it is discovered incidentally. Occasionally pain may be present.</p><h4>Pathology</h4><p>It is related to repetitive stress at the attachment of the adductor magnus aponeurosis at the medial posterior aspect of the distal femoral metaphysis.</p><h5>Location</h5><p>It is seen at the posterior aspect of the distal femur. Can be bilateral in ~ 1/3 of cases.</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Typically shows a saucer-shaped radiolucent cortical irregularity involving posteromedial aspect of the distal femoral metaphysis at the attachment of the adductor magnus tendon. The lesion lacks an outer margin.</p><h5>MRI</h5><p>Defines anatomy much better and is seen as a cortically based lesion in the expected location (i.e. posteromedial distal femoral metaphysis).</p><ul>
Image 4 X-ray (Magnified view ) ( create )
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