Pang Meng-Qi, Wu Feng-Ze, Chen Jia-Yan, Zhu Rang-Teng, Jin Gang, Gong Wei-Jie, Jiang Han-Tao
Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical, Taizhou, Zhejiang, China.
Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical, Taizhou, Zhejiang, China.
Front Oncol. 2025 Jun 17;15:1565771. doi: 10.3389/fonc.2025.1565771. eCollection 2025.
To highlight the diagnostic challenges and clinical implications of metastatic disease presenting as an atypical fracture in a patient with a history of lung cancer, emphasizing the importance of maintaining a high index of suspicion for metastatic disease and the need for comprehensive diagnostic approaches.
We present a case of a 79-year-old male with a history of poorly differentiated squamous cell carcinoma of the left lung who presented with left hip pain after minor trauma. Initial X-ray and CT imaging suggested an avulsion fracture of the femoral lesser trochanter(LT).The patient was managed conservatively with bed rest. However, persistent pain led to further evaluation with MRI, revealing an underlying pathological fracture due to metastatic cancer.
Initial radiographic and CT findings showed a localized bone defect and surrounding soft tissue swelling, consistent with an avulsion fracture of the LT. However, MRI and contrast-enhanced MRI revealed irregularities in the femoral LT with abnormal bone marrow signals and a prominent soft tissue mass, leading to the diagnosis of a pathological fracture secondary to metastatic cancer. This case underscores the limitations of initial imaging modalities in detecting subtle bone marrow changes and the importance of MRI in identifying metastatic lesions.
The misdiagnosis of a pathological fracture as an avulsion fracture can have significant clinical implications, including increased morbidity and delayed treatment of metastatic disease. This case highlights the importance of maintaining a high index of suspicion for metastatic disease, especially in patients with a history of malignancy, and the need for comprehensive diagnostic approaches, including MRI to avoid misdiagnosis. Early recognition and appropriate management of pathological fractures are crucial for improving patient outcomes and quality of life.
强调以非典型骨折形式出现的转移性疾病在肺癌病史患者中的诊断挑战及临床意义，强调对转移性疾病保持高度怀疑指数的重要性以及采用综合诊断方法的必要性。
我们报告一例79岁男性，有左肺低分化鳞状细胞癌病史，在轻微外伤后出现左髋部疼痛。最初的X线和CT成像提示股骨小转子撕脱骨折。患者接受了卧床休息的保守治疗。然而，持续疼痛促使进一步行MRI检查，结果显示为转移性癌所致的病理性骨折。
最初的X线和CT表现显示局部骨缺损及周围软组织肿胀，符合股骨小转子撕脱骨折表现。然而，MRI及增强MRI显示股骨小转子不规则，骨髓信号异常且有明显软组织肿块，从而诊断为转移性癌继发的病理性骨折。该病例强调了初始成像方式在检测细微骨髓变化方面的局限性以及MRI在识别转移灶方面的重要性。
将病理性骨折误诊为撕脱骨折可能具有重大临床意义，包括发病率增加及转移性疾病治疗延迟。该病例强调了对转移性疾病保持高度怀疑指数的重要性，尤其是在有恶性肿瘤病史的患者中，以及采用包括MRI在内的综合诊断方法以避免误诊的必要性。早期识别和恰当处理病理性骨折对于改善患者预后和生活质量至关重要。
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