October 1991

Radiological Case of the Month

Author Affiliations

Contributed from the Departments of Radiology (Dr Kozlowski) and Surgery (Dr Glasson), Royal Alexandra Hospital for Children, Sydney, New South Wales, Australia.

Am J Dis Child. 1991;145(10):1159-1160. doi:10.1001/archpedi.1991.02160100091029

This 3½-year-old girl was referred with a provisional diagnosis of osteomyelitis of the right tibia. She had painless swelling over the upper, medial aspect of the right tibia lasting several months. On physical examination, the swelling was soft, nontender, and extended over 4 cm. Six months earlier, the skin in this area had been penetrated by a palm frond, which had been removed. There was no identifiable skin lesion at the injury site.

Frontal and lateral roentgenograms of the lower leg were obtained (Fig 1) and ultrasonography (Fig 2) of the same region was later performed.

Denouement and Discussion 

Thorn-Induced Pseudotumor of the Tibia  Roentgenography showed a periosteal soft-tissue mass with secondary reactive periosteal thickening. The history of palm frond injury was strongly suggestive of soft tissue and periosteal response (pseudotumor) to an organic foreign body. This supposition was confirmed with ultrasound and operation. At surgery,

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