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Sunburst appearance - bone (ultrasound)

Case contributed by Maulik S Patel
Diagnosis almost certain


Left distal thigh diffuse bulge with mild pain for the last two weeks. No history of trauma or fever.

Patient Data

Age: 10 years
Gender: Male

There is a lesion from the mid-distal diaphysis and metaphyseal region of the left femur. The lesion is mainly hypoechoic ( non-ossified bone ) with new bone formation perpendicular to bone cortex; resulting in a 'sunburst appearance'. The approximate craniocaudal extension is 10 cm.

Quadriceps muscles - tendon are displaced by the lesion. There is no effusion in the suprapatellar recess of knee.

Case Discussion

A child was referred for an ultrasound of thigh for diffuse bulge with mild local pain. Ultrasound shows periosteal reaction around the femur with a sunburst appearance of bone. Considering the age of patient and location in the femur, primary malignant bone tumor, like osteogenic sarcoma, is a very likely possibility.

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