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Post op of metastatic fracture. In response to the different questions: patient knew she had metastatic cancer but was unaware of bone metastasis. It was during self-massage in her bed at home that her bone broke.

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Knee x-ray shows multiple sclerotic foci in the femur and tibia extending to the epiphyses. The sclerotic foci represent multiple bone islands. Patients are typically asymptomatic. The importance of this finding is in confidently making the diagnosis. While sclerotic bone metastases can occasionally mimic this finding, metastases are uncommon in the epiphyses.

AP radiograph of the right hip (image 1) shows an expansile lucent surface lesion (arrow) arising from the medial aspect of the proximal femur diaphysis. Axial (image 2) and coronal (image 3) T2 weighted MRI shows the mass (arrow) contains multiple small cystic spaces with fluid-fluid levels consistent with an aneurysmal bone cyst. Aneurysmal bone cysts are benign lesions. They typically occur in children and adolescents during the second decade of life. Patient's present with pain, swelling, or a palpable mass.

Coronal CT (Image 1), coronal SPECT/CT from Tc-99m MDP bone scan (Image 2), and planar images from Tc-99m MDP bone scan reveal an osteoid osteoma (arrow) in the left femur. This benign bone tumor is recognized by the small lucent nidus and not the pronounced bone formation around it. Commonly located in the femur, these lesions can also appear in the tibia and vertebral bodies. Patients typically experience night-time pain that responds to nonsteroidal anti-inflammatory drugs. Treatment options for osteoid osteoma include ablation or surgical resection.

Conventional #osteosarcoma of the distal femur in a pediatric male patient treated with neoadjuvant chemotherapy. Extensive periosteal reaction with extension into soft tissues. Metastatic tumor was present in the lung.

Additional Cases

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?