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Osteolytic bone metastases

Case contributed by Dr Khalid Alhusseiny

Presentation

Dull aching chest pain and shortness of breath for few days

Patient Data

Age: 40 years
Gender: Male
X-ray

Portable AP view of the chest

There is mild veiling of the right lung field suggesting underlying minimal pleural effusion (there was a history of moderate right pleural effusion 2 weeks earlier). No pulmonary masses or consolidations.

Small dense surgical clips are seen at the neck, denoting thyroidectomy.

There is decrease in T7 vertebral body height with indistinct margins due to underlying osteolytic lesion with transpedicular fixation seen at T6 and T8 levels.

Osteolytic lesions are seen also involving the right aspect of T3 vertebral body and its pedicle, right pedicle of T9 vertebra, left 9th rib posteriorly and left 12th rib at its medial end (these lesions are more conspicuous after modifying the film contrast).

Also there is subtle translucencies seen at the superior aspects of the medial ends of 10th rib on both sides, suggesting underlying osteolytic lesions as well.

X-ray

Annotated magnified images

Red circles are showing the site of post-thyroidectomy surgical clips.

Red arrow points to T7 vertebra which is of reduced height, decreased density and shows ill-defined upper and lower end plates.

Blue arrow points to the lost T9 right pedicle with positive winking owl sign. This is more accentuated by the overlying lung translucency.

Green arrow points to loss of the right lateral border and inferior end plate of T3 vertebral body.

Red star points to a large osteolytic lesion at the posterior aspect of left 9th rib.

Yellow, green and blue stars point to osteolytic lesions at the medial ends of right 10th, left 10th and left 12th ribs, receptively.

Case Discussion

This patient was known to have a history of thyroidectomy for thyroid cancer.

Bone metastases are not common with thyroid cancer, and when present are osteolytic. They are usually asymptomatic but can present with pain if large or associated with fractures.

This case represents an example for the importance of careful evaluation of the thoracic skeleton on portable chest radiographs and the role of adjusting the image contrast in order to enhance the visualization of the bony structures.

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Case information

rID: 78686
Published: 9th Jun 2020
Last edited: 12th Jun 2020
Inclusion in quiz mode: Included

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