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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.