Q. What could cause a lytic bone lesion in the medical end of the clavicle?
Hello doctor,
My CT and MRI scans revealed a lytic bone lesion at the medial end of the left clavicle with adjacent soft tissue mass. An orthopedic surgeon saw this and referred me to an orthopedic oncologist. A biopsy was suggested, but the interventional radiologist assigned to the case reviewed the images and said it was not a good biopsy candidate. So what should I do now?
Kindly help.
Hello,
Welcome to icliniq.com.
Thank you for your query.
I understand your concern. Significant degenerative changes were noted involving the left sternoclavicular joint and mild joint effusion. There is laxity of the capsular ligament. In addition, there is mild irregularity along with erosive changes that are noted involving the medial aspect of the left clavicle. Although no obvious abnormal mass lesion is seen adjacent to this lytic area, the soft tissues adjacent to it appear mildly prominent.
Now looking at the pictures (attachment removed to protect the patient's identity) of severe left sternoclavicular degenerative changes, the small lytic area at the medial clavicular aspect should ideally represent a part of this arthritic process. However, having said that and with a history of previous left shoulder malignant melanoma, our diagnosis should always be guarded in such cases in the sense that any suspicious lesions, even if small in size, should undergo further evaluation just to be sure that we are not missing a more serious underlying pathology.
Since this area is accessible for image-guided biopsy (ultrasound or CT), it can be done for a definitive diagnosis. Whether the procedure will be successful is a separate question, but it should be attempted at least.
When the interventional radiologist denied the biopsy? Was it said after attempting the biopsy procedure, or did he say this by just looking at the images?
I hope this has helped you. Thank you.
Hello doctor,
The interventional radiologist said this just by looking at my images. But unfortunately, I have never spoken with him, and I am still waiting to hear back from them on whether they will schedule the biopsy.
Hello,
Welcome back to icliniq.com.
You will have to wait until the healthcare providers get back to you and see what they say.
I hope this has helped you. Thank you.
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