A young boy presented with a painful left shoulder after a fall.

Left metaphyseal aggressive bone lesion. The differential is wide and includes osteosarcoma and Ewings. LCH should probably also sit in the differential. This does not look like infection.

A fall onto the shoulder has resulted in a pathological fracture.

Staging MR of the humerus confirmed it as a solitary lesion. Referral to the bone tumor service was made. Biopsy confirmed osteosarcoma. Chest CT confirmed multiple lung metastases.