Mahmood GoharThis is a metaphyseal lesion with erosion of physis & epiphysis and periosteal reaction .. in young age .. could be Osteomylitis . Septic arthritis or osteosarcoma . For lab investigations .. CBC ESR CRP ALK.PH MRI..
Abdullrab AlmarwanyaThank you for presenting this case: starting from the reversely posted x-ray of the right upper humerus and shoulder region there is evidence of huge, circular, soft tissue shadow distending the shoulder joint causing the humerus to deviate laterally and inferiorly ,erosive bony resorption and destruction of the medial cortex (cyst formation , reduced metaphyseal bone density)( late x ray changes in OM?? date of x ray??), some bony sclerosis laterally. Taking the patient age,course and the presentation in consideration the diff. could include :Osteomyelitis,Septic arthritis , Osteofibrous dysplasia ,Metastatic rhabdomyosarcoma ,Metastatic neuroblastoma ,Leukemia For working on this differential i would suggest : EXAMINATION: General: condition for evidence of toxic appearance , fever, feeding , taking body weight(??kg). Local :five cardinal sign of inflammation(-+ve). INVEST.: CBC(WBC) ,ESR , CRP ,Plasma procalcitonin ,Blood culture ,Joint aspiration should include cell count with differential ,Gram stain, culture, and sensitivities ,glucose , protein level and histopathology .Bone scan ,Bone Marrow aspiration as indicated. IMAGE: CXR ,soft tissue US for the shoulder , if not helpful one can decide for CT,MRI. THANKS
Los tumores del sistema musculoequelético ya no son una rareza, cada vez se presentan mas en la practica diaria del cirujano ortopedista y de los médicos en general. Se requiere mayor difusión de la información sobre este grupo de enfermedades.
Dr Ernesto Delgado Cedillo