Focal Periphyseal Edema (FOPE lesion) - MSK Radiology
Imaging Findings:
• Arrows identifying the characteristic edema-like signal about the closing physis which extends into both the metaphysis and epiphysis. This abnormal signal is centered about the physis.
• The circle identifies the characteristic "starburst" pattern of edema-like signal that emanates from the closing physis into the metaphysis and epiphysis.
Case description:
• FOPE lesions are a possible etiology for unexplained atraumatic adolescent knee pain.
• Mixed hypothesis of etiology:
- Physiologic process of early physeal fusion and bone bridging that results in increased local stress, especially with activity.
- Pathologic process? Some studies point toward lower physical function after year than their peers and may negatively affect function of adolescents.
• DOES NOT require subspecialty referral, repeated follow-up MRI, or surgical intervention. (save $$)
Differential diagnosis:
• Salter Harris injury: The physis is normal in these cases of periphyseal edema (no widening).
• Bone contusion: Almost always a history of injury with contusion. Also, FOPE is centered about physis and extends into epiphysis and metaphysis, this would be very atypical for contusion.
Dr. Donald von Borstel @DrvonBorstel
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