Presentation
Stem cell treatment for multiple myeloma 5 years prior. CXR for work purposes.
Patient Data
Expansile lucent 'bubbly' lesion in the posterior aspect of the left 5th rib.
No other thoracic cage lesion.
Lungs clear.
Case Discussion
In this case, a medical history was identified for this non-illness based film after inquiry with the patient.
If this was a de-novo lesion a differential for a lucent rib lesion should be followed. In fact, a popular film for fellowship viva examinations.
Because:
1. one needs to spot it (bones important review area of CXR); tests observation
2. give a sensible description of the findings; test of candidates descriptive skills
3. give a sensible differential; several for a lucent rib lesion from benign to malignant
4. check the candidate's advice/management skills
'What would you do next'? Tests if practical advice is given to help the clinician.
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