Lab Studies:
Xray of the R Knee - Normal <a href="CaseStudyImages/CS1NotYourEverydayKn-84.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a>
<br>Xray of the R Hip - AP pelvis and frog lateral view - Non-displaced fracture of acetabulum. Medial portion of the iliac bone was not well defined. <a href="CaseStudyImages/CS2CS1NotYourEveryda-84.jpg" title="Case Photo #2" data-lity><b>Case Photo #2</b></a>
Other Studies:
5/3/10 - Left office with Dx of acetabular fx - Traumatic vs Pathologic. Sent for MRI
<br>5/8/2010 - MRI - Mass involving R acetabulum 8x6.5x6cm with associated bone marrow edema. Medial musculature and vascular structures displaced medially. <a href="CaseStudyImages/CS3CS2CS1NotYourEver-84.jpg" title="Case Photo #3" data-lity><b>Case Photo #3</b></a> <a href="CaseStudyImages/CS4CS3CS2CS1NotYourE-84.jpg" title="Case Photo #4" data-lity><b>Case Photo #4</b></a>
<br>5/12/10 - Bone Scan - abnormal uptake in the R iliac bone, L femur, L humeral head and L ankle. <a href="CaseStudyImages/CS5CS4CS3CS2CS1NotYo-84.jpg" title="Case Photo #5" data-lity><b>Case Photo #5</b></a>
<br>5/12/10 - CT chest/abd/pelvis - normal other than bony processes mentioned previously.
<br>5/12/10 - CBC normal, Differential normal, BUN/Cr normal, Calcium normal, Liver enzymes normal, Total protein elevated at 8.5. Coagulation studies normal, IGA/IGM normal. IGG elevated at 1880
Consultations:
5/17/10 - Ortho Oncology - DDx included Ewings Sarcoma, Giant Cell Tumor, Langerhans cell histiocytosis, Lymphoma, Osteosarcoma, Metastatic carcinoma.
<br>5/21/10 - CT guided biopsy revealed plasma blastic tumor favoring multiple myeloma. SPEP - monoclonal band of IGG kappa paraprotein.
Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.