J Korean Orthop Assoc.  2011 Dec;46(6):507-511.

Simple Subperiosteal Hematoma with a Periosteal Reaction Mimicking a Malignancy

• Cha SM
• Shin HD
• Kim KC
• Hwang JM
• Kim BK

Abstract

A benign periosteal reaction, which can occur after trauma or stress, has a solid and uninterrupted appearance on radiography. In contrast, an aggressive periosteal reaction, which may indicate a malignancy, appears as a Codman's triangle or with a spiculated and sunburst pattern. In the present case, an 11-year-old boy with a previous injury to the distal radial growth plate presented with diffuse osteolysis on the distal radial metaphysis and decreased opacity of the lateral side cortex on plain radiograph. A Codman's triangle-like lesion was seen on the lateral side of the distal radius, and a few spicules were observed on the medial side of the distal radius. A T2-weighted coronal magnetic resonance image revealed a mass that had stripped the periosteum; the mass had heterogeneous signal intensity and a fl uid-fluid level on axial views. The margins of the mass were unclear, but enhanced. Suspecting a primary malignancy, we performed a biopsy. The pathology revealed that the mass was a simple hematoma.

Keyword

periosteum; radius; hematoma

MeSH Terms

Biopsy
Child
Growth Plate
Hematoma
Humans
Magnetic Resonance Spectroscopy
Osteolysis
Periosteum
Radius

Figure

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  Figure 1 (A, B) A radiopaque shadow of the mass border was present on anteroposterior and lateral simple wrist radiographs, and diffuse osteolysis was seen at the distal radial metaphysis. The cortical shadow decreased on the lateral side of the metaphysis. A Codman's triangle-like lesion was seen on the lateral side of the distal radius, and a few spicules were observed on the medial cortex. A Salter-Harris classification I growth plate injury was found on the palmar side of the distal radius on a lateral radiograph, and a linear shadow of periosteal new bone formation was visible. (C, D) Coronal images showed an inhomogeneous high signal-intensity mass. The mass margins were ambiguous and enhanced. The mass was bulging, but the bone marrow showed normal signal intensity.

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  Figure 2 (A) The mass was located on the periosteum. The margin was clear, and the pronator quadratus was compressed. (B) Diffuse hemorrhage with fibrinoid degeneration and acute inflammation was shown at permanent biopsy (H&E stain, ×200).

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  Figure 3 (A, B) The spiculated pattern of the periosteal reaction and Codman's triangle-like lesion were not significant on follow-up radiographs taken 10 weeks later, but a double cortical shadow was present. The patient did not complain of any symptoms.

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