Clinical:
- A 54 years old lady
- Presented with painful swelling of right forearm after a trivial fall
- History of right breast lump for 2 years
- Recently had FNAC done in another hospital
- Defaulted follow up, not sure of FNAC result
Radiographic findings:
- There is transverse fracture of the proximal third of right radial shaft (white arrow).
- Anterior angulation is seen of distal fracture fragment.
- The bone adjacent to fracture site showed permeative lytic changes. This lytic change has wide zone of transition with cortical thinning.
- Another area of lytic change is seen at the radial tuberosity (yellow arrow).
- No periosteal reaction.
- No obvious soft tissue swelling.
Radiological diagnosis: Pathological fracture of right radius
Discussion:
- Pathological fracture is a fracture that occurs through an abnormal bone.
- Most frequently through a metastatic lesion or multiple myeloma.
- Fracture line extend through the destructive bone lesion
- Usually tranverse in direction
- Frequently associated with soft tissue swelling
- The most common locations are subtrochanteric femur, humeral head and vertebral body.
Progress of patient:
- CT scan thorax, abdomen and pelvis done
CT scan findings:
- Advanced lesion involving the right breast (white arrow) with enlarged right axillary nodes (yellow arrow)
- Destructive ytic lesion is also seen involving the left scapula (red arrow)
