April 1, 2009

Proximal leg swelling& tender

A 13 years old malay boy from Kota Bahru presented with pain of the knee joint area. He also complains of LOA, LOW. On further questioning, he reveals the history of trauma to the left leg 7 years ago.

On inspection, there is a swelling measuring about 7 X 4 cm on the proximal part of the leg slightly to the medial part of the leg. The overlying skin is red and there is a present of superficial dilated vein.

On palpation, the swelling is tender, firm in consistency, and ill-defined border.

1) Describe the abnormalities in the X ray

2) What further question you would like to ask

3) What other investigation you would request

4) What is your provisional diagnosis



- Ill defined lytic lesion in proximal metadyphasis of left leg

- Cortical destruction at anterolateral aspect of upper tibia

- Codman triangle at lower part of the lytic lesion


- Any family history of bone cancer

- Any infection of bone

- Is pain aggravated at night?


- Full blood count

- Serum alkaline phosphatase

4) Osteosarcoma

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