PMC7490996_01
Shoulder X-ray post open reduction and internal fixation.
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In July 2017, the patient was admitted to an emergency unit with a fractured humerus after sustaining a minor trauma and underwent open reduction and internal fixation (Fig. 1).
Histological images confirming the diagnosis of osteosarcoma.
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Shortly after, post-operative pain and swelling were noted and he had further imaging that showed pulmonary nodules and left supraclavicular lymph nodes enlargement, Tissue biopsies were done and confirmed a diagnosis of metastatic left proximal humeral osteosarcoma after which treatment was initiated thereby one cycle of cisplatin and doxorubicin and two sessions of radiotherapy (Fig. 2).
First presentation image showing the fungating mass.
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The previous surgical wound had evidence of active bleeding but it was infected and profuse foully smelling discharge was noted from the extensive fungation of the tumor that mandated frequent dressing changes daily (Fig. 3).
Staging MRI showing the extension of the tumor.
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As an inpatient, he had magnetic resonance imaging (MRI) of the left shoulder that showed evidence of left humeral fixation with a metallic artifact, and a massive destructive proximal left humeral lesion with an associated huge soft tissue component measuring 23 cm x 20 cm in axial dimension and 24 cm in craniocaudal dimension (Fig. 4).
Intra-operative images showing complete resection and identification of the clavicle.
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After copious irrigation, insured hemostasis, closure in layers was done under negative suction (Fig. 5).
Post-operative image.
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He was transferred back to the surgical ward on postoperative day one then was discharged on day eleven on analgesics and anticoagulants after a smooth post-operative course (Fig. 6) and was followed up by occupational physiotherapy and pain clinic.
Staging vs. follow up chest CT scan showing metastatic progression.
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