A 29-year-old woman presents for evaluation of left-sided back and hip pain that started about one month ago. She denies any injury or trauma. She describes the pain as “a constant, deep, sharp ache,” aggravated by weight bearing.
Her medical history is significant for a diagnosis of lymphoma two years ago. She was treated with chemotherapy and is considered to be in remission. Otherwise, her history is unremarkable.
Physical exam demonstrates no obvious deformity. There is generalized local tenderness over the lumbosacral region. A radiograph of the pelvis is shown.
Answer
The radiograph demonstrates extensive bone destruction within the left sacrum, as well as a lytic lesion within the proximal left femur. Both findings most likely reflect a recurrence of the patient’s lymphoma.
A biopsy subsequently confirmed this diagnosis. The patient was tentatively scheduled for more chemotherapy, as well as radiation therapy.
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