EURORAD ESR

Case 14861

Langerhans cell histiocytosis, classic findings in a paediatric patient

Author(s)
Bosca-Ramon A, Dualde-Beltran D, Nersesyan N, Flores-Casaperalta S, Delgado-Moraleda JJ,

Hospital Clínico Universitario de Valencia;
Email:antonibosca@gmail.com
 
Patient
male, 13 month(s)
 
 
  • Figure 1
    Cervical US

    Ultrasound showed bilateral cervical lymphadenopathy. The largest lymph node was on the right, measuring approx. 8 x 2 cm

     
    Area of Interest: Haematologic; Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;
     
     
  • Figure 2
    Plain radiography
     

    Right frontal lytic lesion with beveled edges (hole within a hole sign). A right occipital lytic lesion is also seen.

     
    Area of Interest: Oncology; Paediatric; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Annotated image. Right frontal lytic lesion with beveled edges (hole within a hole sign). A right occipital lytic lesion is also seen.

     
    Area of Interest: Oncology; Paediatric; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Right frontal and occiptal lytic lesions.

     
    Area of Interest: Oncology; Paediatric; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Annotated image. Right frontal and occiptal lytic lesions.

     
    Area of Interest: Oncology; Paediatric; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;
     
     
  • Figure 3
    Craneal CT with IVC
     

    Axial CT shows right frontal lytic lesion. Note the asymmetric destruction of the inner and outer cortices, which results in a characteristic beveled edge.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Axial CT shows another right frontal lytic lesion.

     
    Area of Interest: Haematologic; Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Axial CT shows right occipital lesion.

     
    Area of Interest: Haematologic; Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;
     
     
  • Figure 4
    Cervical and thoracic CT with IVC
     

    Axial CT shows right mandibular lytic lesion.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Coronal CT shows right mandibular and left temporal lytic lesions.

     
    Area of Interest: Bones; Haematologic; Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Coronal CT shows right mandibular and left temporal lytic lesions.

     
    Area of Interest: Bones; Haematologic; Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    T4 uniform collapse (vertebra plana) is seen. Note the preservation of the adjacent intervertebral disk spaces. T9 and T10 partial collapse, 4th and 9th left rib lytic lesions and bilateral cervical lymphadenopathy...

     
    Area of Interest: Bones; Haematologic; Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    T4 uniform collapse (vertebra plana) is seen. Note the preservation of the adjacent intervertebral disk spaces. T9 and T10 partial collapse, 4th and 9th left rib lytic lesions and bilateral cervical lymphadenopathy...

     
    Area of Interest: Bones; Haematologic; Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Sagittal CT shows vertebra plana. Lytic lesions on clinoid, clivus, odontoid, T9 and T10 vertebral bodies, and T1 spinous process are also present.

     
    Area of Interest: Bones; Haematologic; Head and neck; Imaging Technique: Catheter arteriography; CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Sagittal CT shows vertebra plana. Lytic lesions on clinoid, clivus, odontoid, T9 and T10 vertebral bodies, and T1 spinous process are also present.

     
    Area of Interest: Bones; Haematologic; Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Axial CT image shows irregular lytic lesions in a midthoracic vertebral body, spinous process, and left ribs.

     
    Area of Interest: Bones; Haematologic; Paediatric; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Axial CT image shows irregular lytic lesions in a midthoracic vertebral body, spinous process, and left ribs.

     
    Area of Interest: Bones; Haematologic; Paediatric; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;
     
     
  • Figure 5
    Cerebral MR
     

    Axial 3D FSPGR T1-weighted MR image shows skull lesion, with typical asymmetric destruction of the inner and outer cortices.

     
    Area of Interest: Bones; Head and neck; Paediatric; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Sagittal FSE T1 weighted MR image shows preserved posterior pituitary bright spot.

     
    Area of Interest: Oncology; Paediatric; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Sagittal FSE contrast-enhanced T1-weighted MR image shows a normal thin pituitary stalk.

     
    Area of Interest: Oncology; Paediatric; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;
     
     
  • Figure 6
    Spine MR
     

    Coronal STIR MR shows T4 uniform collapse (vertebra plana). T9 and T10 partial collapse.

     
    Area of Interest: Bones; Haematologic; Paediatric; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;

    Sagittal STIR MR shows T4 uniform collapse (vertebra plana). T9 and T10 partial collapse.

     
    Area of Interest: Bones; Haematologic; Paediatric; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haematologic diseases;
     
     
Ultrasound showed bilateral cervical lymphadenopathy. The largest lymph node was on the right, measuring approx. 8 x 2 cm
 
Right frontal lytic lesion with beveled edges (hole within a hole sign). A right occipital lytic lesion is also seen.
 
Annotated image. Right frontal lytic lesion with beveled edges (hole within a hole sign). A right occipital lytic lesion is also seen.
 
Right frontal and occiptal lytic lesions.
 
Annotated image. Right frontal and occiptal lytic lesions.
 
Axial CT shows right frontal lytic lesion. Note the asymmetric destruction of the inner and outer cortices, which results in a characteristic beveled edge.
 
Axial CT shows another right frontal lytic lesion.
 
Axial CT shows right occipital lesion.
 
Axial CT shows right mandibular lytic lesion.
 
Coronal CT shows right mandibular and left temporal lytic lesions.
 
Coronal CT shows right mandibular and left temporal lytic lesions.
 
T4 uniform collapse (vertebra plana) is seen. Note the preservation of the adjacent intervertebral disk spaces. T9 and T10 partial collapse, 4th and 9th left rib lytic lesions and bilateral cervical lymphadenopathy are also seen.
 
T4 uniform collapse (vertebra plana) is seen. Note the preservation of the adjacent intervertebral disk spaces. T9 and T10 partial collapse, 4th and 9th left rib lytic lesions and bilateral cervical lymphadenopathy are also seen.
 
Sagittal CT shows vertebra plana. Lytic lesions on clinoid, clivus, odontoid, T9 and T10 vertebral bodies, and T1 spinous process are also present.
 
Sagittal CT shows vertebra plana. Lytic lesions on clinoid, clivus, odontoid, T9 and T10 vertebral bodies, and T1 spinous process are also present.
 
Axial CT image shows irregular lytic lesions in a midthoracic vertebral body, spinous process, and left ribs.
 
Axial CT image shows irregular lytic lesions in a midthoracic vertebral body, spinous process, and left ribs.
 
Axial 3D FSPGR T1-weighted MR image shows skull lesion, with typical asymmetric destruction of the inner and outer cortices.
 
Sagittal FSE T1 weighted MR image shows preserved posterior pituitary bright spot.
 
Sagittal FSE contrast-enhanced T1-weighted MR image shows a normal thin pituitary stalk.
 
Coronal STIR MR shows T4 uniform collapse (vertebra plana). T9 and T10 partial collapse.
 
Sagittal STIR MR shows T4 uniform collapse (vertebra plana). T9 and T10 partial collapse.
 
 
 
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