Pediatric emergency medicine trisk 2708 2708
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begins with steroids, most commonly dexamethasone at a starting dose of 0.25 to
0.5 mg/kg IV (maximum dose is usually 10 mg as an initial dose followed by doses
of 4 mg every 6 hours thereafter). Multispecialty consultation with neurosurgery,
radiation oncology, and pediatric oncology is optimal when choosing among
surgical decompression, radiation therapy, and chemotherapy. Decisions must
consider both the short-term efficacy of the treatment to relieve the compression as
well as the long-term consequences.
TUMORS OF BONE
Goal of Treatment
Many patients with newly diagnosed bone tumors may be able to be discharged with
proper subspecialty follow-up. If discharged, consider immobilizing the affected
extremity in efforts to prevent the development of a pathologic fracture.
CLINICAL PEARLS AND PITFALLS
A history of trauma does not rule out a malignant etiology of bone pain.
Radiographic signs of bone malignancy include periosteal elevation,
ossification of soft tissue masses in a “sunburst” pattern, and lytic lesions
with irregular borders.
Current Evidence
Primary bone tumors are uncommon pediatric malignancies, but bone tumors are the
third most frequent malignancy of adolescent and young adults. In the United States,
it is estimated that 2,400 primary bone tumors are diagnosed annually in children.
Osteosarcoma and Ewing sarcoma are the most common primary malignant bone
tumors. Osteosarcoma is characterized by its production of immature bone or
osteoid. It is the most common malignant bone tumor in children and adolescents,
presenting most often in the second and third decades of life. Although Ewing
sarcoma is second to osteosarcoma in overall frequency, it affects children and
adolescents of all ages and is more common than osteosarcoma in children younger
than 10 years. Leukemia, lymphoma, LCH, and metastases from neuroblastoma,
sarcomas, and other childhood tumors can all cause bone pain and abnormalities on
radiograph ( Fig. 98.3 ).
Clinical Considerations
Clinical Recognition
The differential diagnosis of a bony mass includes both benign and malignant
entities. Subacute osteomyelitis can present with fever, elevated inflammatory
