title: Extremity pain in a child: a case report of leukemia.
abstract: Early clinical diagnosis of leukemia in a child is difficult. Leukemia must be considered in the differential diagnosis of extremity pain in children, especially if the "bone" pain is out of proportion to a suspected etiology. Initial laboratory studies, radiographs, and scintigraphy may be normal. Indistinct radiographic findings of periosteal reaction, osteolytic lesions, sclerotic lesions, osteopenia, or leukemic lines in a child older than two years should alert a physician to the possibility of leukemia. Clinical suspicion of leukemia should be piqued if bone scan results seem to be inconsistent with a suspected diagnosis or unanticipated sites of increased metabolic activity are found in the lower extremities. If leukemia is probable, a bone marrow aspiration may be needed to confirm the diagnosis.
authors.affiliation: Department of Orthopaedics, Alfred I. Dupont Hospital for Children, Wilmington, Delaware, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Bowen
authors.forename: D
authors.initials: D
authors.lastname: Andrisani
authors.forename: K
authors.initials: K
authors.lastname: Miller
mesh_terms: D002648:Child; D006801:Humans; D007866:Leg; D008297:Male; D010146:Pain / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000175:diagnosis