ACEP ID:

Pediatric Emergency Medicine

Case Study of the Month-June

 Mohsen Saidinejad, MD, MBA

 

 Children’s National Medical Center, Washington, DC

    

 A 15-year-old male presents to the ED with a 2-day history of intermittent pain in the right lower extremity.  He denies any trauma or any similar previous episodes.  He has been afebrile, but has had increasing pain with flexion and extension of the right knee and with standing.  He has been physically more active recently. He states that he has had no swelling or redness over the knee joint. He is fully immunized and the rest of his history is unremarkable.  He denies any pain at the present time.

  

 Physical examination reveals full range of motion of the hip, knee, and ankle joints, although the patient does express discomfort with hyperflexion and full extension of the knee.  No erythema, swelling, or warmth is noted over the knee joint.  Complete blood count and inflammatory markings were within acceptable normal limits.  An x-ray of the right knee reveals a lesion in the distal femur as shown here.  What is the next step in management of this finding?

  June Case Image 1     

 June Case Image 2

 

 

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