Presentation
Few weeks of neck and right shoulder/arm pain.
Patient Data
Ill-defined lucency in the proximal humeral metadiaphysis with cortical thinning and permeative appearance.
Large lesion within the proximal humeral shaft with its epicenter at the level of the surgical neck of humerus. It extends superiorly beyond the level of the physeal scar. Ill-defined with posterior cortical breach with an extraosseous soft tissue component underlying the tenoperiosteal attachments of the deltoid muscle. Immature periostitis surrounds the proximal femoral shaft. A very small degree of likely intra-lesional hemorrhage characterized by high T1 signal and low T2 signal.
High signal of the adjacent LHB tendon sheath. Mild synovitis of the right glenohumeral joint.
On the periphery of the acquisition, ill-defined multifocal contrast enhancement within the scapula and also at least two upper ribs.
Case Discussion
The primary differential diagnosis for this lesion was skeletal metastases given the multiplicity of enhancing lesions in the proximal humerus, ribs and scapular with hypervascular metastases such as renal cell cancer or even atypical breast cancer metastasis considered although there was no history of known malignancy. Subsequent follow-up with the patient's oncologist reported that the final diagnosis was metastatic angiosarcoma.
Case courtesy of Dr Alex Davies.
Unable to process the form. Check for errors and try again.