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What Causes Multiple Spots In Tibia On MRI Suggestive Of Metastatic Disease?
Dear Doctor,
My mother is a 50 yr old lady with a
1. h/o menorrhagia on and off since 3 yrs(USG _UTERINE FIBROIDS)
2. h/o Right sided renal calculi 4yrs back for which PCNL was done. Since then she has had 2 episodes of small renal calculi which subsided with fluids and ayurvedic medication.
3. h/o Back pain 1 yr back lasting for about a month (x ray showed osteoarthritic changes in the spine) Her Vit D level one year back was 8ng/ml. Nothing was done about the low vit D levels. Her back pain eventually subsided with physiotherapy and pain killers.
HER PRESENT HISTORY ..
1. h/o right sided leg pain on and off since 3 months following a trivial injury. X-ray showed an expansile lesion in the diaphysis of the fibula towards its upper end. MRI showed extent of the lesion . It extended beyond the cortex into the soft tissue. Also there were multiple spots in the tibia which raised the suspicion of metastatic disease. On examination ..she is in fairly good condition . BP and blood sugars are normal. Evaluation for primary was done.
Chest x-ray, mammography, USG kidney were normal. USG thyroid showed 2 nodules , one in the right lobe and one in the isthmus which radiologically looked benign. She is now referred for PET scan.
2. Last month she had an episode of renal colic for which CT was done.. It showed a small renal calculus and an asymptomatic gall stone. Her urologist did a serum calcium (which was low) and a VIT D level (6ng/ml which was also low). He started her on calcium and vit D supplements.
3. Her current relevant investigations are as follows. Serum calcium-9.6 ( normal range 8.5-10.5), alkaline phosphatase 80 u/l ,haemoglobin 9gm/dl, PCV, MCV, MCH,MCHc are all slightly low.
4. Sir,I would like to know does this look like a metastatic disease or could it be something else. I’m really worried about my mom. Please Advise….
Thanking you..
Yours sincerely
Divya
My mother is a 50 yr old lady with a
1. h/o menorrhagia on and off since 3 yrs(USG _UTERINE FIBROIDS)
2. h/o Right sided renal calculi 4yrs back for which PCNL was done. Since then she has had 2 episodes of small renal calculi which subsided with fluids and ayurvedic medication.
3. h/o Back pain 1 yr back lasting for about a month (x ray showed osteoarthritic changes in the spine) Her Vit D level one year back was 8ng/ml. Nothing was done about the low vit D levels. Her back pain eventually subsided with physiotherapy and pain killers.
HER PRESENT HISTORY ..
1. h/o right sided leg pain on and off since 3 months following a trivial injury. X-ray showed an expansile lesion in the diaphysis of the fibula towards its upper end. MRI showed extent of the lesion . It extended beyond the cortex into the soft tissue. Also there were multiple spots in the tibia which raised the suspicion of metastatic disease. On examination ..she is in fairly good condition . BP and blood sugars are normal. Evaluation for primary was done.
Chest x-ray, mammography, USG kidney were normal. USG thyroid showed 2 nodules , one in the right lobe and one in the isthmus which radiologically looked benign. She is now referred for PET scan.
2. Last month she had an episode of renal colic for which CT was done.. It showed a small renal calculus and an asymptomatic gall stone. Her urologist did a serum calcium (which was low) and a VIT D level (6ng/ml which was also low). He started her on calcium and vit D supplements.
3. Her current relevant investigations are as follows. Serum calcium-9.6 ( normal range 8.5-10.5), alkaline phosphatase 80 u/l ,haemoglobin 9gm/dl, PCV, MCV, MCH,MCHc are all slightly low.
4. Sir,I would like to know does this look like a metastatic disease or could it be something else. I’m really worried about my mom. Please Advise….
Thanking you..
Yours sincerely
Divya
