January 16, 2010

24 Years Old Girl with History of Bone Osteosarcoma Presented with Loss of consciousness

This Chest X- ray and Brain CT Scan belongs to a 24 years old Malay girl who was bought unconsciously to the casualty. Her GCS at arrivals is 3 and was intubated. She has history of bone osteosarcoma of the hip


1) Give your findings.

2) What is your diagnosis?

3) Outline your management to this patient.


  1. 1) Diffuse reticulo nodular infiltration?
    2) Lymphangitis carcinomatosis
    3) not sure about this ct brain. Is it brain metastases?

    *i'm preparing for my exam. can you check my answer?


  2. XHest X rays shows multiple cannon ball lesion with some hazziness with poorly defined border. Otherwise no bone infiltration

    CT brain shows two rounded mass at right occipito temporal region. mass is surrounded by hyperdense lesion with irregular shape,most likely intracerebral bleeding. the midline shifted to the left side with obliteration of intraventricular canal. Possible of Intraventricular hemorrhage as well. The sulci-gyrus dififferentiation is loss which indicate brain edema.

    Both CT and CXR shows that the patient suffed from Intracerebral bleed with midline shift with underlying osteosarcoma of the hips with distant metastasis to the brain and lung. Prognosis is poor and conservative management is opted.

    THis type of patient is not for intubation or ICU intubation and should be just managed conservatively.


Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.