Clinical Cases

This woman is 52. She has multiple skin abnormalities as shown in the photographs. What is the most common skeletal manifestation of this disorder?

The patient is 15, and he has had pain and a bump on his left shin for one or two years. He has been taking aspirin once in the morning and once at night, which controls the pain effectively. The pain is worse at night and in the first thing in the morning.

The patient is a 25-year-old male who has a history of an ankle sprain some months ago. He has had persistent swelling in the ankle. He is working as a painter. There is pain in the ankle in the mornings and after workouts.

The patient is 16, and he had a spraining injury to the left ankle, whereupon an x-ray of the ankle was taken. This showed a lesion in the left calcaneus.

An active thirty-one year old woman had focal back pain and a lesion in the second lumbar vertebra. Initial work-up including a CT revealed a solitary,lesion with a latent appearance. Primary treatment was non-operative, but after six months the pain was still present, and the patient complained of significant limitations of her lifestyle and was unable to perform many outdoor activities.

The patient is a very pleasant woman who is an active tennis player and 50 years of age. She has had aching pain in the left knee and a radiograph revealed a bone lesion in the proximal tibia. The patient is seen at the request of her orthopedic surgeon.

A 14 year old boy presents with pain and a mass above the knee.

A 35 year old auto mechanic whose wife had just had their first baby presented with severe pain in the distal femur. Subsequent work up showed multiple ipsilateral lesions. Pathology images from a similar lesion are shown.

A 43 year old woman with a history of breast cancer with bone metastasis presents with severe hip pain and inability to walk. Plain radiographs and a CT image of her right proximal femur are shown.

The patient is a very pleasant 36 year old woman who has noticed a pain in the foot since approximately one month ago.

An 11 year old boy had pain in the left shoulder. A left proximal humeral lesion was noted on plain radiographs and CT images, which are shown.

An eight year old girl has pain and swelling of he left tibia just below the knee on the medial side.

An eighteen month old boy whose parents are from Laos had fevers, ear pain, and irritability for 6 months. His birth and early developmental status had been normal. Several trips to the doctor and antibiotics for what was considered to be chronic otitis media had been ineffectual.

A 18 year old male had pain and swelling in the foot. A biopsy of the calcaneal lesion is taken.The patient had a complete work-up. No abnormality was found in the lungs. A mass was noted in the ipsilateral popliteal fossa.

A 26 year old male came in with a mass near his right knee.
The patient was generally healthy, had no significant medical problems. His family history was unremakable. He had had several surgeries for removal of other masss from his bones and for correction of deformities of his forearm.

A 52 year old man had a six week history of aching pain in the shoulder at rest and with activities. On exam, there was pain and tenderness over the proximal humerus and the anterolateral arm, as well as pain with abduction and limitation of motion of the shoulder.

The lesion has a latent appearance and there is no sign of progressive growth. This coupled with the central, metaphyseal location, as well as the dense matrix calcification showing "rings and arcs" (see inset images) identify this lesion as an enchondroma.

A 14 year old girl complained of a vague aching pain in her knee for two months. Exam showed a firm, slightly tender mass palpable on the surface of the posterior femur in the lateral popliteal fossa and no other findings. She had no night pain, no definite benefit from aspirin, no history of injury and was otherwise in excellent health. Laboratory exams were unremarkable.

A 17 year old boy presented with a three month history of swelling near his knee, and recent onset of moderate pain. He was otherwise hale and hearty.

A 27 year old man presented with a four month history of a mass in his palm. He had no history of trauma. Examination showed a firm, fixed, slightly tender mass in the palm of his right dominant hand. The balance of the exam and the laboratory results were unremarkable.

The patient is a very pleasant 57-year-old woman who has pain and a lesion in the talus bone. She was initially seen by a variety of practitioners, including one who gave her an injection for gout or for arthritis. The patient is generally healthy.