Hello. My name is Jack Henry, DC, DACBR. I am Radiologist-in-Chief of
Radiology Diagnostics, LLC, an industry leader of Chiropractic Radiology Services and Digitized Spinographic analyses. All of our services are provided at no cost to doctor and no/low cost to patients.
Selected cases will be presented for your evaluation. The studies may or may not have abnormalities. Use the arrow keys or the scroll bar to carefully evaluate the films.
Step 1: Is the study abnormal or normal?
Step 2: If the study is abnormal, what is your best diagnosis?
Step 3: Which follow-up imaging option would be best?
Step 4: Compare your results with the correct diagnosis.
HISTORY
A 42-year-old female reports with severe low back and left hip pain of three weeks duration. The patient has difficulty weight bearing. Orthopedic evaluation was equivocal due to pain. Neurological exam was unremarkable. The patient has a history of breast CA with subsequent right mastectomy, chemotherapy, and radiation therapy in 2007 and 2008.
FINDINGS
The study is somewhat overexposed. Osteopenia is noted throughout the structures visualized. Please note the interrupted cortex of the left pelvic brim and the lytic permeative pattern of bony destruction involving the adjacent region of the left iliac neck. The lesion’s zone of transition is long. The left hip appears uninvolved at this time, albeit with plain film evaluation.
DISCUSSION
A lytic destructive lesion in a patient with a history of breast carcinoma points directly toward metastasis.
FOLLOW UP PROTOCOL
Pathological fractures must be avoided. The patient should not bear weight and be directly referred to her oncology team.