MRI LOWER LIMBS AND PELVIS - MSK - WITH CONTRAST
Plain films of the left tibia and fibula reviewed. Extensive femoral and tibial periosteal reaction and coarse, altered medullary bone.
Extensive bilateral parosteal soft tissue surrounding both femurs, most pronounced in the distal metaphyseal and epiphyseal regions. This extends along more than half of the diaphysis on the left femur and measures up to 1.5cm in depth at the left distal metaphysis. This gives a laminated onion skin'' appearance of the bones (on axial images).
The cortex of the femurs remains intact, but altered enhancing bone marrow in the left femur is evident.
Similar findings are present in both tibias with parosteal soft tissue up to 7 mm in depth and altered bone marrow signal. The cortex of the left tibia is irregular and breached. The distal left tibia is similarly involved.
Two morphologically abnormal lymph nodes on the medial aspect of the left knee measuring 2.8 cm and 1.1cm. 1 cm big left inguinal lymph node.
Increased parosteal soft tissue surrounding the left distal radial and ulnar metaphyses on the localiser images.
In summary: The appearances are most suggestive of a haematological malignancy, such as leukaemia.
The differential of stage IV nephroblastoma is unlikely as an ultrasound of the abdomen and both CXR/AXR has not identified a primary.