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X-ray of the tibia fibula. (a) Antero-posterior (AP) view. (b) lateral view.
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A plain radiograph of the left leg (Figure 1) demonstrated increased lucency in the medullary canal extending from the proximal diaphysis of the mid-shaft with normal cortical appearance and no periosteal reaction or evidence of fractures.
MRI of left tibia with/without IV contrast.
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Magnetic resonance imaging (MRI) of the left leg revealed findings consistent with diffuse intramedullary metastasis involving the left tibia, visualized distal left femur, and proximal/mid-right tibia (Figure 2).
Whole body PET/CT scan.
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Following this new diagnosis, she underwent a positron emission tomography with computed tomography (PET/CT) scan which reported extensive disease involvement in both tibias, left humerus, and likely left mandible, as well as extensive adenopathy which extended from the supraclavicular region to the distal left external iliac system, believed to be due to her lymphoma (Figure 3).
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