Cortical desmoid
Updates to Article Attributes
Cortical desmoids, also known as cortical avulsive injuries, are a benign self-limiting entity. This is a classic 'don't touch' lesion, and should not be confused with an aggressive 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 medial head of gastrocnemius or distal adductor magnus aponeurosis at the posterior medial aspect of the distal femoral metaphysis.
Location
It is seen at the posterior aspect of the distal femur. Can be bilateral in approximately one-third of cases.
Radiographic features
Radiograph
Typically shows a saucer-shaped radiolucent cortical radiolucent cortical irregularity involving the posteromedial aspect of the distal femoral metaphysis at 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) 3,4:
- T1: low signal
- T2: high signal and surrounding low signal rim may be present
- T1 C+ (Gd): most show enhancement
Nuclear medicine
On bone scan, there is an abnormal increase in activity because of the chronic stress/traumatic origin of this lesion.
Differential diagnosis
Imaging differential considerations include
Practical points
- cortical desmoid
isis one of theskeletalskeletal “don’t touch” lesions
-<p><strong>Cortical desmoids</strong>, also known as <strong>cortical avulsive injuries</strong>, are a benign self-limiting entity. This is a classic 'don't touch' lesion, and should not be confused with an aggressive 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 posterior medial 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 approximately one-third of cases.</p><h4>Radiographic features</h4><h5>Radiograph</h5><p>Typically shows a saucer-shaped radiolucent cortical irregularity involving the posteromedial aspect of the distal femoral metaphysis at the attachment of the <a href="/articles/adductor-magnus">adductor magnus</a> 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) <sup>3,4</sup>:</p><ul>- +<p><strong>Cortical desmoids</strong>, also known as <strong>cortical avulsive injuries</strong>, are a benign self-limiting entity. This is a classic 'don't touch' lesion, and should not be confused with an aggressive 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 medial head of gastrocnemius or distal adductor magnus at the posterior medial 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 approximately one-third of cases.</p><h4>Radiographic features</h4><h5>Radiograph</h5><p>Typically shows a saucer-shaped radiolucent cortical irregularity involving the posteromedial aspect of the distal femoral metaphysis at the attachment of the <a href="/articles/adductor-magnus">adductor magnus</a> 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) <sup>3,4</sup>:</p><ul>
-</ul><h5>Nuclear medicine</h5><p>On bone scan, there is an abnormal increase in activity because of the chronic stress/traumatic origin of this lesion.</p><h4>Differential diagnosis</h4><p>Imaging differential considerations include</p><ul><li><a href="/articles/fibrous-cortical-defect">fibrous cortical defect</a></li></ul><h4>Practical points</h4><ul><li>cortical desmoid is one of the skeletal <a href="/articles/skeletal-do-not-touch-lesions-1">“don’t touch” lesions</a>- +</ul><h5>Nuclear medicine</h5><p>On bone scan, there is an abnormal increase in activity because of the chronic stress/traumatic origin of this lesion.</p><h4>Differential diagnosis</h4><p>Imaging differential considerations include</p><ul><li><a href="/articles/fibrous-cortical-defect">fibrous cortical defect</a></li></ul><h4>Practical points</h4><ul><li>cortical desmoid is one of the skeletal <a href="/articles/skeletal-do-not-touch-lesions-1">“don’t touch” lesions</a>
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