Case of the Month

Rizzoli Case 7

A 10 year old male had pain in the left shoulder for six months. An initial radiograph (shown) was interpreted as showing a non-displaced fracture. A slight fever was noticed which diminished after treastment with antibiotics.

The symptoms continued and a new radiograph (seen here) was performed, which showed marked changes in the left clavicle.

On admission the patient's temperature ws 37.5°C. His WBC was 8.5 (4.5 - 9.5) with a normal differential. His electrolytes and liver function tests were normal, and the alkaline phosphatase was 738 (up to 740). The erythrocyte sedimentation rate was 52 (up to 15) and the protein C was 0.72 (up to 0.5).

On examination his clavicle was enlarged and slightly tender. There were no neurovascular or cutaneous abnormalities. The motion of the left upper extremity was unimpaired.

Construct a differential diagnosis that has at least three entities; including a benign tumor, a malignant tumor, and a non-tumorous condition.

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