Percorsi clinici
La diagnosi differenziale del dolore osseo in età pediatrica: quando preoccuparsi
The differential diagnosis of paediatric bone pain: when to be concerned
Roberta Barolo1, Sebastian Dorin Asaftei2
1Scuola di Specializzazione in Pediatria, Ospedale Infantile “Regina Margherita”, Università di Torino
2Oncoematologia Pediatrica, Ospedale Infantile “Regina Margherita”, Torino
Novembre 2023 - pagg. 581 -587 | DOI: 10.53126/MEB42581
Abstract
Bone pain is a common cause of admission to the Paediatric Emergency Department. Although in most cases it is associated with benign processes, this symptom should be investigated thoroughly when anamnestic and clinical features suggest the possible presence of an underlying malignant process. This article describes the case of an adolescent presenting with persistent musculoskeletal pain, initially treated as an infectious bone disease that later turned out to be a malignant neoplasm. Based on clinical, laboratory and imaging data the differential diagnosis of paediatric bone pain can sometimes be challenging and includes nonneoplastic diseases, benign bone tumours and malignant bone tumours. Moreover, this article indicates the medical history data to be investigated, the signs and symptoms to be evaluated and the laboratory and imaging investigations to be performed in a paediatric patient with bone pain. In addition, the epidemiological, clinical and radiographic characteristics of the most frequent causes of paediatric bone pain are summarized in a final table.
Riassunto
Il dolore osseo è una causa comune di ricovero al Pronto Soccorso Pediatrico. Sebbene nella maggior parte dei casi sia associato a processi benigni, questo sintomo va indagato approfonditamente quando caratteristiche anamnestiche e cliniche suggeriscono la possibile presenza di un processo maligno sottostante. Questo articolo descrive il caso di un adolescente che presentava dolore muscoloscheletrico persistente, inizialmente trattato come una malattia ossea infettiva che successivamente si rivelò essere una neoplasia maligna. Sulla base di dati clinici, di laboratorio e di imaging, la diagnosi differenziale del dolore osseo pediatrico può talvolta essere difficile e comprende malattie non neoplastiche, tumori ossei benigni e tumori ossei maligni. Inoltre in questo articolo vengono indicati i dati anamnestici da indagare, i segni e sintomi da valutare e le indagini di laboratorio e per immagini da eseguire in un paziente pediatrico con dolore osseo. Inoltre, in una tabella finale sono riassunte le caratteristiche epidemiologiche, cliniche e radiografiche delle cause più frequenti di dolore osseo in età pediatrica.
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Corrispondenza: roberta.barolo93@gmail.com