#Prep_pearls
Initial evaluation of an adolescent or older child presenting with bone pain and swelling, especially with a palpable mass, should include:
o Plain radiographs (two views) of the suspected lesions, although no single feature on radiographs is diagnostic. Osteosarcomatous lesions can be purely osteolytic (about 30% of patients), purely osteoblastic (about 45% of patients), or a mixture of both. Elevation of the periosteum may appear as the characteristic Codman triangle. Extension of tumor through the periosteum may result in a so-called "sunburst appearance" (about 60% of patients).
o Both magnetic resonance imaging of the primary lesion and computed tomography scan of the chest are necessary to confirm the diagnosis and for staging purposes. Such scans frequently are performed at the tertiary center using their protocols.
Initial evaluation of an adolescent or older child presenting with bone pain and swelling, especially with a palpable mass, should include:
o Plain radiographs (two views) of the suspected lesions, although no single feature on radiographs is diagnostic. Osteosarcomatous lesions can be purely osteolytic (about 30% of patients), purely osteoblastic (about 45% of patients), or a mixture of both. Elevation of the periosteum may appear as the characteristic Codman triangle. Extension of tumor through the periosteum may result in a so-called "sunburst appearance" (about 60% of patients).
o Both magnetic resonance imaging of the primary lesion and computed tomography scan of the chest are necessary to confirm the diagnosis and for staging purposes. Such scans frequently are performed at the tertiary center using their protocols.