PMC7276614_01
(a and b) An well-defined mixed lytic sclerotic lesion with surrounding sclerosis noted in the distal end of humerus at the lateral margin of the olecranon fossa. (c) The previous biopsy tract which did not lead to the lesion.
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F2
As the lesion was in the para-olecranon region, it was probably not reached during the attempted curettage (Fig. 2c), and hence, he had persistent pain even after the surgery. X-ray and computed tomography right elbow showed features of osteolytic lesion involving right lateral humeral condyle just adjacent to olecranon fossa (Fig. 2a and b).
Post-operative X-ray right elbow anteroposterior and lateral views showing lesion excision and antibiotic (vancomycin) impregnated Stimulan beads application at the posterolateral aspect of distal humerus.
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F3
After extended curettage of lesion with burr, the defect was packed with bone substitute vancomycin-impregnated calcium sulfate (Stimulan) beads as we suspected infection (Fig. 3).
Photomicrographs the intraosseous lesion composed of crowded blood vessels of variable sizes and shapes (Hematoxylin and eosin, x100); the presence of elastic lamina and fibers in the thickened arterial and venous walls (arrows) (Masson's trichrome stain, x100).
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F4
Surprisingly, the biopsy was reported as an intraosseous arteriovenous malformation (Fig. 4).
(a and b) Post-operative full range of elbow movements.
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F5
Postoperatively, the patient was followed up at 1 month, 3 months, 6 months, and 1 year and he gradually recovered full range of elbow motion with incorporation of bone graft substitutes (Fig. 5).