La diagnosi differenziale del dolore osseo in età pediatrica: quando preoccuparsi

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.