Interactive Transcript
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This was a one-year-old who presented with
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pain along the right lateral orbit.
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The serial imaging here shows a lesion which is
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involving the lateral orbital wall and superior orbital
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wall. It is a bony lesion in a one-year-old.
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Our differential diagnosis for bone lesions in the
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infant and young toddler age includes Langerhans
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cell histiocytosis. Alternatively,
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one might suggest a possible diagnosis of neuroblastoma
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with a primary tumor in the abdomen and secondary
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involvement of the bones of the face and/or
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the skull all comers throughout the world.
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One also might consider involvement of tuberculosis
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affecting the skull and the facial bones.
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In this case,
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the patient shows heterogeneous signal intensity on the
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FLAIR imaging as well as T2-weighted scans
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as well as the post-contrast scans.
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We also note that there appears to be some extraosseous
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involvement with soft tissue enhancement that is
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occurring along the temporalis muscle at the edge of the skull.
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What would be helpful is to have the CT scan in this
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case to identify whether or not this was a punched-out
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lesion that one would expect with Langerhans cell
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histiocytosis. Indeed, that was the case.
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However, we get the sense of that on the axial post-contrast imaging
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and scan where we are losing the edge of the lesion at the bony margin.
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In this age group,
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the best diagnosis is Langerhans cell histiocytosis.
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