Caso

Case report
An 8-year-old boy was referred to our Vascular Anomalies
Center for management of a painful femoral lesion. At the age
of 7 years, the child developed intermittent right leg pain aftersustaining a fall during horse-riding. Pain was localized to the
lower thigh and upper calf with throbbing, occasionally
nocturnal nature. Pain was partially relieved by non-steroidalanti-inflammatory analgesics. No other systemic symptoms
were reported. Initial orthopedic assessment revealed minimal
tenderness over the knee and distal thigh with no swelling,
neurovascular deficit, lossof range of motion or cutaneous
changes. Apart from urinary tract and middle ear infections,
the child was healthy with no relevant prenatal or family
history.
Initial radiographs demonstratedmultiple small, welldefined
geographic lytic lesions within the medullary and
subcortical regions of the distal metadiaphysis of the femur,
some of which showed focal encroachment of the endostealsurface and sclerotic borders. The lesions were more
confluent at the distal metaphyseal region with curvilinear
configuration. No internal matrix was identified. There
were no fractures, periostealreaction or soft tissue swelling
(Fig. 1). Intraosseous vascular malformation was the main diagnostic consideration, with neoplasms and osteomyelitis
being the less likely differential diagnoses.Clinical examination at our center confirmed the lack of
a soft tissue mass or abnormal vasculature within the right
leg. Incidentally, a purplish-stained cutaneous lesion with a
central blackenedarea was found on the volar side of his
right wrist; most likely representing a verrucous hemangioma
or angiokeratoma.
One-month follow-up plain radiographs revealed a stable
appearance. Ultrasounddepicted multiple small cortical
defects within the distal femur, with no high-flow vascular
component (Fig. 2). Bone scintigraphy showed no increased
tracer uptake in the corresponding lytic...