Leg Pain and Swelling in a 22-Year-Old Man

Abstract

The patient was a 22-year man who presented with right leg pain and swelling that had increased during the last 6 years. He complained of pain with walking and running, which precluded him from participating in any sports, and night pain. The patient localized the pain over the anterior aspect of the midtibia. He denied any history of trauma. He required regular doses of oxycodone for the past year to achieve adequate pain relief. His past medical history was unremarkable. On physical examination a large anterior pretibial bony mass was palpable. No other masses were palpable in the extremities and there was no evidence of lymphadenopathy. Active and passive range of motion testing and neurovascular examination was in normal limits. Plain radiographs and MRI scans of the leg, along with CT scan of the leg and chest, were obtained (Figs 1–3). Based on the history, physical examination and radiographic imaging, what is the differential diagnosis? From the *Departments of Orthopedic Surgery, †Radiology, and ‡Pathology; University of Pittsburgh Medical Center, Pittsburgh, PA. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the reporting of this case report and that all investigations were conducted in conformity with ethical principles of research. Correspondence to: Richard McGough, MD, Department of Orthopedic Surgery, 5200 Centre Avenue, Suite 415, Pittsburgh, PA 15232. Phone: 412802-4100; Fax: 412-802-4120; E-mail: mcgoughrl@upmc.edu. DOI: 10.1097/01.blo.0000195924.36103.11 CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 448, pp. 259–266 © 2006 Lippincott Williams & Wilkins