Lab Studies:
CBC (complete blood count), ESR (erythrocyte sedimentation rate), TSH (thyroid stimulating hormone), Iron studies, and Vitamin D were all within normal limits
CMP (Complete metabolic panel) revealed albumin 5.3 (high), but otherwise was within normal limits
Other Studies:
Xray left hip, femur, knee: no acute fractures
MR left thigh without contrast at outside hospital: no stress fracture however +T2 elongated signal in distal femur without periostitis was noted Case Photo #1
MR left thigh without contrast on re-read: findings were compatible with gelatinous translation of the bone marrow. Correlate clinically with malnutrition
DEXA scan: lowest Z score -0.8 at lumbar spine
Consultations:
In the setting of a reassuring CBC (complete blood count) and known malnutrition, a Hematology consultation did not recommend further bone marrow evaluation unless she failed to respond to nutritional optimization.
Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.