Clinical Presentation

An 8-year-old boy with fatigue and joint pain.

(A–C) Plain films: There is osteopenia, particularly in the carpal bones. In the distal ulna, there is a radiolucent trans-verse metaphyseal band with “moth-eaten” destruction of the proximal edge and a periosteal reaction (arrow). There is a focal osteolytic lesion in the distal radius (arrowhead).

Differential Diagnosis

• Leukemia: These films show multiple findings common in leukemia.

• Osteomyelitis: Can appear aggressive, similar to leukemia (periosteal reaction, bone destruction), and have similar symptoms. Transverse metaphyseal bands are more common in leukemia.

• Metastatic neuroblastoma: Often difficult to distinguish from leukemia. Can have metaphyseal bands and bone destruction.

Essential Facts