Cortical desmoid: Misnomer as biology & histology differ from true desmoid tumors (which are locally aggressive benign neoplasms)
Definitions
Irregularity of posterior, medial distal femoral metaphyseal cortex deep to attachments of gastrocnemius muscle medial head or adductor magnus aponeurosis
Benign self-limited lesion likely due to chronic avulsion
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Lerisson H et al: Radiographic/MR imaging correlation of the pediatric knee growth. Magn Reson Imaging Clin N Am. 27(4):737-51, 2019
Kay M et al: Cortical desmoid of the humerus: radiographic and MRI correlation. Skeletal Radiol. 46(7):1011-5, 2017
Tscholl PM et al: Cortical desmoids in adolescent top-level athletes. Acta Radiol Open. 4(5):2058460115580878, 2015
Thapa MM et al: MRI of pediatric patients: part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol. 198(5):W456-65, 2012
Hall FM: Cortical desmoid: a misnomer? AJR Am J Roentgenol. 197(4):1022; author reply 1023, 2011
Vieira RL et al: MRI features of cortical desmoid in acute knee trauma. AJR Am J Roentgenol. 196(2):424-8, 2011
Kontogeorgakos VA et al: Cortical desmoid and the four clinical scenarios. Arch Orthop Trauma Surg. 129(6):779-85, 2009
Gould CF et al: Bone tumor mimics: avoiding misdiagnosis. Curr Probl Diagn Radiol. 36(3):124-41, 2007
Connolly SA et al: Avulsive cortical irregularity and F-18 FDG PET. Clin Nucl Med. 31(2):87-9, 2006
Jung C et al: Symptomatic cortical desmoids detected on knee SPECT. Clin Nucl Med. 27(6):437-8, 2002
Donnelly LF et al: Chronic avulsive injury of the deltoid insertion in adolescents: imaging findings in three cases. Radiology. 211(1):233-6, 1999
Yamazaki T et al: MR findings of avulsive cortical irregularity of the distal femur. Skeletal Radiol. 24(1):43-6, 1995
Craigen MA et al: Symptomatic cortical irregularities of the distal femur simulating malignancy. J Bone Joint Surg Br. 76(5):814-7, 1994
Resnick D et al: Distal femoral cortical defects, irregularities, and excavations. Radiology. 143(2):345-54, 1982
Brower AC et al: Histological nature of the cortical irregularity of the medial posterior distal femoral metaphysis in children. Radiology. 99(2):389-92, 1971
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KEY FACTS
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TERMINOLOGY
Abbreviations
Distal femoral avulsive irregularity (DFAI)
Synonyms
Benign cortical irregularity of distal femur
Avulsive cortical irregularity or tug lesion
Cortical desmoid: Misnomer as biology & histology differ from true desmoid tumors (which are locally aggressive benign neoplasms)
Definitions
Irregularity of posterior, medial distal femoral metaphyseal cortex deep to attachments of gastrocnemius muscle medial head or adductor magnus aponeurosis
Benign self-limited lesion likely due to chronic avulsion
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Lerisson H et al: Radiographic/MR imaging correlation of the pediatric knee growth. Magn Reson Imaging Clin N Am. 27(4):737-51, 2019
Kay M et al: Cortical desmoid of the humerus: radiographic and MRI correlation. Skeletal Radiol. 46(7):1011-5, 2017
Tscholl PM et al: Cortical desmoids in adolescent top-level athletes. Acta Radiol Open. 4(5):2058460115580878, 2015
Thapa MM et al: MRI of pediatric patients: part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol. 198(5):W456-65, 2012
Hall FM: Cortical desmoid: a misnomer? AJR Am J Roentgenol. 197(4):1022; author reply 1023, 2011
Vieira RL et al: MRI features of cortical desmoid in acute knee trauma. AJR Am J Roentgenol. 196(2):424-8, 2011
Kontogeorgakos VA et al: Cortical desmoid and the four clinical scenarios. Arch Orthop Trauma Surg. 129(6):779-85, 2009
Gould CF et al: Bone tumor mimics: avoiding misdiagnosis. Curr Probl Diagn Radiol. 36(3):124-41, 2007
Connolly SA et al: Avulsive cortical irregularity and F-18 FDG PET. Clin Nucl Med. 31(2):87-9, 2006
Jung C et al: Symptomatic cortical desmoids detected on knee SPECT. Clin Nucl Med. 27(6):437-8, 2002
Donnelly LF et al: Chronic avulsive injury of the deltoid insertion in adolescents: imaging findings in three cases. Radiology. 211(1):233-6, 1999
Yamazaki T et al: MR findings of avulsive cortical irregularity of the distal femur. Skeletal Radiol. 24(1):43-6, 1995
Craigen MA et al: Symptomatic cortical irregularities of the distal femur simulating malignancy. J Bone Joint Surg Br. 76(5):814-7, 1994
Resnick D et al: Distal femoral cortical defects, irregularities, and excavations. Radiology. 143(2):345-54, 1982
Brower AC et al: Histological nature of the cortical irregularity of the medial posterior distal femoral metaphysis in children. Radiology. 99(2):389-92, 1971
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