Plain radiographs Case Photo #1 , MRI Case Photo #2 Case Photo #3 , and CT Case Photo #4 [Photo5] were ordered over the following week and the findings supported the initial clinical diagnosis of a stress fracture. Imaging revealed a cortical defect with minimal reactive edema. The patient was prescribed a period of rest refraining from running or strenuous activity and regular dosing of anti-inflammatory medication. At the 3-month follow-up, the patient noticed no significant improvement in pain. Repeat radiographs Case Photo #6 and MRI Case Photo #7 Case Photo #8 were performed. Results showed the lesion had increased in size and had penetrated the intramedullary space.
Because of the persisting symptoms and change in appearance of the lesion on imaging, a referral to an orthopedic oncologist was established. A repeat MRI with contrast was conducted prior to the scheduled bone biopsy.
Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.