Clinical Pathways
Clinical Pathways
Bone Tumors - Pediatric
Bone Tumors - Pediatric

Bone Tumors - Pediatric

Tags
Ped. Emerg. Med. Practice
Published
July 1, 2021
Author(s)
Mahnoosh Nik-Ahd, MD, MPH, FAAP; Anurag K. Agrawal, MD; Melissa Zimel, MD, FAAOS

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Action

Patient presents with focal or regional pain

Decision

Does the patient have respiratory symptoms?

icon
Yes → Obtain chest x-ray and laboratory studies

Background

Laboratory studies:

  • Complete blood cell count with differential
  • Complete metabolic panel
  • Magnesium
  • Phosphorus
  • C-reactive protein
  • Erythrocyte sedimentation rate
  • Lactate dehydrogenase
  • Blood culture (if febrile or history of fevers)

Obtain a thorough history of the patient’s pain, particularly the severity, timing (eg, nocturnal, activity-related), and duration. Pain is often described as dull or achy and not severe, even for malignant lesions. Night pain should raise concern for neoplasm. Pain in the absence of trauma should also raise concern for a tumor. However, many children (especially athletes) may have a minor sports injury that can distract parents and clinicians from the possibility of a tumor.

Additional complaints that may present secondary to malignant bone tumors are respiratory symptoms (eg, shortness of breath, orthopnea, and cough) and neurologic symptoms (eg, neck, back, or radicular pain; paresthesias; urinary retention; bowel/bladder incontinence; and gait abnormalities). While other primary neurologic conditions (eg, Guillain-Barré syndrome and transverse myelitis) have similar symptoms, bone tumors generally cause a more sub-acute/chronic duration of these symptoms, with the exception of Ewing sarcoma, which can cause cord compression syndrome more acutely.

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References
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