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Musculoskeletal Imaging

Pseudotumour, haemophilic

a large, expansile lesion produced by subperiosteal and intraosseous bleeding, occurring expecially in the femur and ilium. Pseudotumours of bone and soft tissue are relatively uncommon. Within bones the small or large radiolucent lesions are fairly well demarcated. In the immature skeleton, accumulation of blood may result in lifting of the periosteum. Other features of the condition are cortical atrophy due to abnormal pressure, subperiosteal bone formation and soft tissue extension. Tumours arising in the soft tissue enlarge slowly and distort the subjacent osseous tissue by pressure erosion. Large and disorganized lesions can lead to pathologic fracture (Fig.1). Subperiosteal haemophilic pseudotumours can simulate malignancy (Ewings sarcoma), skeletal metastases) or infection. See haemophilia (III:1), Fig. 5.

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Fig.1

AP radiograph of the femur demonstrates multiple osteolytic and expansile "bubbly" lesion in the femoral shaft and nearly complete destruction of the distal femur with a huge soft tissue mass.
Pseudotumour, haemophilic, Fig.1