Osteosarcoma: femur

Case contributed by Dr Ian Bickle


Teenager with intractable left leg pain. No trauma.


Immature skeleton.

Destruction of the distal femoral metaphysis with sunburst periosteal reaction and lifting up of the periosteum ("Codman's triangle").

Annotated image

The uplifting of the periosteum - given the name Codman's triangle - is indicated by the arrow.

Nuclear medicine

Intense tracer uptake in the distal left femoral metaphysis extending to the physis.

No synchronous lesion.

Case Discussion

Primary osteosarcoma typically occurs in young patients (10-20 years) with 75% occurring before the age of 20.  

This is logical because the growth centers of the bone are more active during the puberty to adolescence time period.

The usual location is in the metaphyseal regions of long bones, and have a strong predilection for the knee, with up to 60% at this site.

The tumor typically causes:

  • medullary and cortical bone destruction
  • a wide zone of transition, permeative or moth-eaten appearance
  • aggressive periosteal reaction including both sunburst type and Codman triangle (as in this case)
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Case information

rID: 37962
Published: 30th Jun 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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