FOREARM LUMP AND OSTEOPOROSIS

• Main Authors: Mara Carsote, Simona Elena Albu, Florin Sandru, Mihai Cristian Dumitrascu, Anda Dumitrascu, Ana Valea
• Format: Article
• Language: English
• Published: Amaltea Medical Publishing House 2019-12-01
• Series: Romanian Journal of Medical Practice
• Subjects: lump; forearm; osteoporosis; bone
• Online Access: https://revistemedicale.amaltea.ro/Romanian_Journal_of_MEDICAL_PRACTICE/Practica_medicala-2019-Nr.4/RJMP_2019_4_Art-19.pdf
• ISSN: 1842-8258; 2069-6108

We introduce a case of a menopausal woman newly diagnosed with primary osteoporosis who has been detected with a forearm lump. A 57-year old female is confirmed with osteoporosis at DXA. The patient developed within 10 days a painful lump with local redness at dorso-medial part of left forearm. Apparently no local trauma was identified. Neither had she a general infection or any other condition in the mean time. The ultrasound identified a hypoechoic area of 4 by 1.3 by 4 cm, with positive Doppler signal. A local infection was considered and she was offered antibiotics for 10 days. However, since the patient also accused bone pain, she was re-referred for an endocrine assessment. The hormonal panel was consistent with the first assays. Also a mild inflammatory syndrome was detected based on erythrocytes sedimentation rate of 31 mm/1-hour (normal: < 25 mm/1-h) and C reactive protein of 1.4 mg/dl (normal: < 1 ng/ml). An X - Ray of the region was done and showed no anomaly. The bone whole body scintigram was negative at forearm but a fracture rib at the level of 9th left rib was identified and considered osteoporotic. A computed tomography showed the subcutaneous localisation of the lump with small calcifications and no bone involvement. Paget’s disease of the bone was excluded based on normal bone turnover markers and negative bone scintigram. The proximity with a bone disease diagnosis needs to differentiate a subcutaneous lesion from a potential bone deformity caused by a metabolic bone condition.