Unicameral bone cyst with pathological fracture

Case contributed by Dr Ian Bickle

Presentation

Teenager with left upper arm pain. Clinician concerned over osteomalacia.

Patient Data

Age: 15 years
Gender: Male

Skeletally immature patient.

Lucent expansile lesion with a narrow zone of transition in the proximal metaphysis of the left humerus.  Cortical thinning of both the medial and lateral surfaces.

X-ray

Films from prior admission

Fracture through the proximal metaphyseal lucent lesion.

No fragment within the lesion.

Case Discussion

A decent starter film for a fellowship exam.  A lucent bone lesion.

The examiner can use this film to:

1. assess the candidate's ability to describe a focal bone lesion

2. assess knowledge depth through inquiry into a differential

3. inquire further into additional imaging which may help (e.g. MRI to see fluid-fluid levels to distinguish between a unicameral bone cyst and aneurysmal bone cyst)

4. assess if the candidate gives a common sense/most likely diagnosis and management plan

The reality is on plain film alone it is difficult to be definitive, especially between the chief two differentials of UBC and ABC.

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Case information

rID: 60133
Published: 9th May 2018
Last edited: 14th Aug 2019
Tag: ripas2
Inclusion in quiz mode: Included
Institution: Rotherham Foundation Hospital Trust

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