Review Question - QID 782

The radiograph shows a destructive lesion of the distal femur. As this is likely a malignancy (osteosarcoma) it should be staged prior to biopsy, as described by Simon and Finn. CT of the chest, bone scan, and MRI of the femur should be performed before biopsy to look for skip lesions. CT looks for metastasis to lung tissue, which is the most common site of disseminated disease caused by malignant primary bone and soft-tissue tumors.

Observation with follow-up radiographs is not appropriate because this lesion is painful and radiographically aggressive. While infection should be suspected in children with pain and radiographic changes concerning for osteomyelitis, IV antibiotics are inappropriate because the patient’s history does not suggest an infectious etiology and further noninvasive workup is necessary prior to invasive methods. Radiation, chemotherapy, and wide excision should not be performed prior to the appropriate work-up and staging.