As of the latest update, Google Chrome and Microsoft Edge have made a breaking change to how file uploads are handled. Once your system installs this update, you will not be able to upload new images. Please use another browser until we can get it fixed.

Osteosarcoma of the first metacarpal

Case contributed by Dr Matt Skalski


Progressing thenar pain and weakness of the thumb.

Patient Data

Age: 60
Gender: Female

There is subtle permeative lytic destruction of the first metacarpal, with questionable areas of cortical destruction throughout the diaphysis. On the lateral view, subtle periosteal elevation is appreciated along the dorsomedial aspect of the proxmial metaphysis of the first metacarpal.

There are also mild degerative changes at the second, third, and fourth distal interphalangeal joint, scaphotrapezial joint and 1st metacarpophalangeal with joint space narrowing  and osteophytosis. 

A 2.2 x 1.3 x 2.6 cm enhancing soft tissue mass is observed along the dorsolateral aspect of the right first metacarpal, consistent with residual or recurrent tumor, as the patient reports history of osteosarcoma status post chemotherapy.

The mass envelops the extensor pollicis longus and extensor pollicis brevis tendons, without definite invasion of the underlying metacarpal; however, an abnormal low T1 high STIR signal is seen within the 1st metacarpal diaphysis, which likely represnts osteosarcoma with in the bone, but also has a double line appearance suggestive of bone infarction.  If infarction, it is likely secondary to prior radiation therapy in the region.


Status post amputation of 1st and 2nd ray, including trapezium and trapezoid. No interval complicaton or evidence of recurrence is seen.

Case Discussion

Although the findings related to osteosarcoma in the inital film are subtle, they are present and warrant further investigation, especially given that the degnerative changes don't fit the clinical complaint. 

PlayAdd to Share

Case information

rID: 27397
Published: 1st Feb 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

Updating… Please wait.

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

 Thank you for updating your details.