Presentation
Left shoulder pain and swelling.
Patient Data
Ill-defined lytic lesions of the left glenoid and proximal humerus with the focal loss of the cortex at the humerus head and irregularity of the glenoid inferior cortex.
Abnormal signal (low on T1/intermediate on T2/PDFS) soft tissue lytic destructive osseous lesions involving the glenoid and proximal humerus causing the cortical destruction of the humerus and glenoid posterior cortex and a soft tissue component which expands mildly out of the posterior side of the lesions.
Abnormal intrasubstance increased fluid signal and thickening along with supraspinatus, infraspinatus, and subscapularis tendons related to tendinosis.
Moderate joint effusion.
Subcoracoid and subacromial/subdeltoid bursa.
Tenosynovitis of the long head of the biceps tendon.
Capsular hypertrophy and degenerative changes along with the AC joint.
Acromion type II.
Degenerative changes as cartilage thinning and fraying associated with subchondral cystic changes at the glenoid bone.
Case Discussion
The glenoid and humerus lesion's imaging appearances are in keeping with a malignant bone lesion.
Metastasis, chondrosarcoma, osteosarcoma, and lymphoma could be considered in the differential diagnosis.
This patient had no known background of malignancy and refused biopsy or follow-up management of the osteolytic lesions.