Fluid-fluid levels in aneurysmal bone cysts
The present case has been reported in the Journal of Pediatrics.

An 11-year-old girl complained about persistent thoracolumbar junction pain. Magnetic resonance imaging revealed a lesion in the body of L1. Biopsy confirmed the lesion as an aneurysmal bone cyst. Several endovascular embolization procedures were attempted, with poor results.

The lesion grew progressively over the next 5 months, extending into the posterior elements and surrounding soft tissues and encasing the spinal cord. Pain increased, making it impossible for the patient to sit for prolonged periods or ambulate long distances.

Puncture with curettage and stem cell injection was attempted with no success, and en block tumor resection followed by arthrodesis with bone graft reconstruction was performed.

Case highlights:-
- Radiologically, ABCs appear as well-defined, expansive radiolucent lesions located eccentrically in the metaphysis. They may demonstrate thin sclerotic margins.

- CT is useful for assessing cortical breach and detecting associated soft tissue mass. Fluid-fluid level is a characteristic, but not unique, finding on magnetic resonance imaging (Figure).

- Fluid-fluid levels are represented by blood-filled lakes between fibrous septa with hematocrit gravitational effects correlated with their characteristic histological features.

- The case shows a very large lesion, larger than usual, involving posterior elements and also the vertebral body.

- The main line of treatment is surgery with curettage and bone grafting.

- The use of percutaneous techniques with fibrosing agents is also extended, either in isolation or as an initial approach before surgical treatment.

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