Clinical Cases

The patient is a very pleasant woman who states that she bumped her forearm on the right side approximately 2 years ago, and has noticed a lump there since then. She believes it has not changed in size, but it has become more painful.

Examination shows that there is a palpable but ill-defined mass on the ulnar border of the forearm, about midshaft. It feels to be about 3 cm in length. It is tender. There is no pulsations and no warmth. No regional or central lymphadenopathy. No associated skin lesion.

A 21 year old student has had pain in the left heel for two years and is otherwise healthy. Examination of the left foot shows slight swelling in the medial and lateral border of the calcaneus. There is point tenderness over the Achilles insertion and the posterior calcaneus.

A 27 year old man who works in a motorcycle shop has a stiff knee and a large, but not very painful mass in his knee. He comes in because he can't bend his knee far enough to do his job.

A 14 year old skater has knee pain for 6 months.

A 58 year old woman has multiple lesions in multiple bones. She complains of "achy bones". She is weak, and has been confused and forgetful recently.

A 27 year old man has 14 month history of knee pain that was minor at first and accompanied by low grade fevers. After several months, warmth and swelling in the knee developed and an xray was taken.

A woman who had a bone scan for back pain was found to have an abnormality in the right femoral hear. The exam is normal, and there is no pain.

A 39 year old woman had a history of shortened, deformed extremities and previously had corrective surgery. The patient now presents complaining of left hip pain at the side of a lesion that has previously been operated.

The patient is 29 and complained of pain and swelling in his left shoulder that was markedly swollen compared to the right. This had been present for nearly four years, and had gradually gotten worse over that time.

This man is 71. He has thigh pain and xrays were ordered. The radiologist made the following statement in the report: "The appearance is consistent with a malignant sarcoma or a metastatic cancer." What do you think?

An ten year old girl presented to her primary care physician with pain after a fall in a soccer game. The initial radiograph is shown at left as the main image.

A 39 year old man had a history of pain and progressive loss of motion of the left hip and knee.

A 28 year old man from northern Italy complained of mild difficulty walking for one year. He did not complain of pain. The patient had no history of unusual travel or exposure.

A 12 year old boy from Sicily had a history of mild trauma to the right leg approximately one month prior to presentation. He presented with mild pain and a mass near the right knee.

This 37 year old IT manager has 6 months of mild thigh pain, which gradually has gotten worse and is now bothering him at night.

A 67 year old woman has knee pain, and xrays that show a lesion has developed in a previously normal part of her distal femur sometime over the last two years.

The patient is a generally healthy 30-year-old woman who is right handed. She noticed a dramatic onset of pain in the right wrist when something went crack during normal activities.

The patient is 51 and healthy. She states that she sustained a fall and injury to the right shoulder, which developed substantial bruising and swelling that extended down the arm almost to the elbow.

The patient is 25. She was found to have Still’s disease, and treatment consisted of prednisone, with gradually escalating doses, ultimately culminating in a dosage of up to 70 mg daily, continuing for about 3 months.

The patient is a very pleasant 45-year-old banker who has noticed a mass in the right foot for approximately 6 months.