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elbow and forearm, distal humerus

12 year old boy with right elbow pain and stiffness

Submitted by henry on Thu, 11/05/2009 - 17:20
Case Identification
Case ID Number: 
20091105AR
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 12 year old boy was referred from outside center following a three week history of worsening right elbow pain.In addition to the pain, the patient also had significantly reduced range of motion, and when seen in the clinic had only 20 degree range of active motion. His elbow is remarkably tender with significant effusion also.

Image Reference: 
20091105AR
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A lytic lesion in the distal humerus

Submitted by henry on Wed, 07/28/2010 - 13:09
Case Identification
Case ID Number: 
20100728DH
Periosteal Reaction: 
absent
Benign/Malignant: 
Malignant
Clinical case information
Case presentation: 

This 60-year-old right handed woman has had gradual onset of pain in the right elbow. X-rays show a destructive bone lesion in the distal humerus. Further radiographic evaluation has shown that there is a 6.9 cm mass in the lower pole of the left kidney. It has a heterogeneous appearance consistent with renal cell carcinoma. The bone scan shows multiple areas of abnormality, including two lesions in the skull.

Radiological findings:: 
The plain radiographs of the right distal humerus show an aggressive destructive process centered just above the olecranon fossa. The lesion is purely lytic and the surrounding bone shows a permeative pattern of destruction. The lesion measures approximately 40 by 30 mm, and the medial cortex of the humerus has been damaged and appeared to be slightly fractured. There is no periosteal reaction and no visible ossification within the substance of the lesion. The MRI shows a mass occupying the upper portion of the olecranon fossa and projecting anteriorly into the soft tissues.
Treatment Options:: 
The right distal humerus lesion is large and there is clearly a high risk of fracture. Hopefully this can be stabilized rapidly before the patient has a fracture. This area cannot be stabilized with a rod, since it is too distal. Rodding of renal cell carcinoma lesions may lead to recurrence since they are not sensitive to radiotherapy. Options for the right distal humerus lesion include complete resection with reconstruction with an elbow prosthesis, or curettage of the lesion and packing with cement, combined with plating of the distal humerus. Both options should give the patient a durable reconstruction.
Image Reference: 
A lytic lesion in the distal humerus
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A smoker with elbow pain

Submitted by henry on Tue, 07/21/2009 - 22:20
Case Identification
Case ID Number: 
20090721AS
Periosteal Reaction: 
absent
Benign/Malignant: 
Malignant
Clinical case information
Case presentation: 

This 67 year old male has pain and a mass in the right dominant elbow. He had a history of smoking for many years. Work-up revealed a lytic lesion in the distal humerus.

Radiological findings:: 
An aggressive lytic destructive lesion has destruyed most of the humerus just above the elbow. No matrix is seen and no periosteal reaction is evident. A bone scan shows the lesion, but no other abnormal areas. An MRI shows the lesion has expanded aggressively into the soft tissues.
Treatment Options:: 
This lesion could be a primary sarcoma, if so what type is most likely? What would you do? This lesions might also be a metastatic tumor - if so what is the most likely source? What should be done in that case?
Image Reference: 
A smoker with elbow pain
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A woman who bumped her arm 2 years ago

Submitted by henry on Tue, 07/28/2009 - 16:33
Case Identification
Case ID Number: 
20090728BA
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

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.

Radiological findings:: 
X-rays show that there is a lesion in the superficial cortex of the ulna, in the same place as the palpable bump, with lytic destruction of the cortex of the ulna and an expansile mass with a very thin periosteal shell.
Image Reference: 
A woman who bumped her arm 2 years ago
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