BONE MASS OR SWELLING

Ask the following questions:

1. Is there a history of trauma? Trauma, of course, may cause fractures and subperiosteal hematomas.
2. Is the patient a child or an adult? Children are more likely to have Ewing's tumors, scurvy, rickets, syphilis, battered baby syndrome, osteosarcoma, osteomas, and osteochondromas. Adults are more likely to have a giant cell tumor, metastasis, osteomyelitis, osteogenic sarcoma, fibrosarcoma, multiple myeloma, generalized fibrocystic disease, Paget's disease, acromegaly, and chondromas.
3. Are the lesions single or focal or are they multiple or diffuse? Multiple and diffuse lesions in children are often due to scurvy, rickets, syphilis, and battered baby syndrome. Multiple lesions or diffuse lesions in adults are often due to metastasis, multiple myeloma, generalized fibrocystic disease, Paget's disease, acromegaly, and chondroma. Single lesions in children are more likely to be fracture, osteomyelitis, hematoma, Ewing's tumor, osteosarcoma, osteomas, and osteochondromas. Single lesions in adults are often due to a giant cell tumor, osteomyelitis, fracture, hematoma, osteogenic sarcoma, and fibrosarcoma, but may be due to a metastasis.
4. Are the lesions usually painful? Painful lesions in children are more likely to be due to fracture, osteomyelitis, hematoma, Ewing's tumors, scurvy, syphilis, battered baby syndrome, and rickets. Painful lesions in adults may be due to a giant cell tumor, metastasis, osteomyelitis, fracture, hematomas, osteogenic sarcoma, fibrosarcomas, and multiple myeloma.

DIAGNOSTIC WORKUP

Routine diagnostic studies include a CBC, sedimentation rate, urinalysis, chemistry panel, arthritis panel, serum protein electrophoresis, and plain films of the involved bones. A skeletal survey may be necessary. Bone scans are often useful. A search for a primary tumor may require chest x-ray, upper GI series, barium enema, intravenous pyelogram, mammography, prostatic examination, PSA titer, thyroid scans, lymph node biopsy, and bone marrow examinations.

CT scans of the area may help differentiate the mass or swelling. Needle biopsy or exploratory surgery and bone biopsy may be necessary before deciding what surgical approach should be undertaken.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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