IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Metastasis to humerus - pathological fracture

Case contributed by Frank Gaillard
Diagnosis certain
  • Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Whole body isotope bone scan

Nuclear medicine

Intense uptake in the upper left humeral shaft is consistent with the recent fracture. Focal moderate uptake in the left 6th rib laterally is non-specific, but more likely to represent an old fracture than a bone metastasis. No other significant abnormalities are seen.

Impression: No bone metastases other than the left humerus are identified. Non-specific uptake is seen in the left 6th rib.

CT Chest: A large lobulated heterogeneous mass measuring up to 12.5cm is identified in the right lower anterior hemithorax. It appears to replace the right middle lobe. It appears to directly infiltrate the mediastinal fat. A large right pleural effusion is seen with extensive pleural thickening which appears to involve both the parietal and visceral pleura. Collapse affects both the upper and lower lobes. Extensive subcarinal and para-esophageal lymph node enlargement is seen measuring up to 3.8cm axially. The left lung and pleural space are clear.

CT Humerus: Permeative lytic bone destruction affects the proximal left humerus with an oblique pathological fracture.

Case Discussion

This patient went on to have histological confirmation of carcinoma of the lung (non-small cell). 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.