Title: October 2016 – Case of the Month

Honorable Mention Award Winner, ISCD Clinical Case Comptetition, 2016 Annual Meeting, Galway Ireland.

Submitted By:
Lawrence G. Jankowski, CBDT

Affiliation:
Illinois Bone and Joint Institute, LLC. Morton Grove, Illinois, USA

Patient History:
A 79 year old male with 7 cm loss of height from self reported maximum and back pain was referred for bone density testing. An unusual expansion of lateral distal shaft of right hip was noted on DXA scanning. (Image 1, arrow). Bilateral reflex Single Energy (SE) femur examinations were performed per department protocol (Image 2). History was negative for bisphosphonate exposure. The patient indicated no history of prior fractures on his medical intake form.

Image 1:

oct-2016-1

Area of irregular cortex noted on DXA of right femur.

Image 2:

oct-2016-2

Irregular periosteal irregularites seen bilaterally on femur surveys using a DXA scanner.

Questions:

  1. What is the most likely etiology of the abnormal areas seen on the femur images?
  2. What, if any, additional testing would you perform?

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