Dificultades en el Diagnóstico de Metástasis Ósea en Un Caso con Fractura Patológica

Abstract

The present case is a patient of 78 years old, mestizo, She born and resident in Chibuleo, widow, without any level of instruction, farmer occupation; Clinical-pathological background personal respiratory infection a repetition. Approximately about 12 hours ago before joining suffers drop its own height, impacting left upper and lower limb on hard surface, presenting pain moderate intensity and difficulty in mobility, so she goes to Ambato Teaching Hospital. During the interrogation present cough with yellowish expectoration of 2-month history of mild and predominantly nocturnal. Emergency patient receives TA 110 / 70mmHg FC: 77pm FR: 11 p.m., sat O2 84%, the environment, aware, not fever, algic presents cyanosis, symmetrical Thorax, decreased expandability, Lung breath sounds decreased in right lung field, crackles are heard in lung bases. Edematous left upper limb deformity in the middle third of the arm, painful on palpation and limited mobility, lower left presence of edema that leaves fovea member. It is a tests are performed, the same report. Rx Left humerus fracture in the middle third. Rx femur and left hip: osteolytic lesions in iliac crest and femoral metaphyses suggestive of bone metastases. Chest radiography veiling of right lung and pleural effusion on the same side so it is drained by three times. Simple chest CT lung metastasis, metastasis third costal arch It remains hospitalized for 14 days receiving antibiotics and pain killers awaiting surgery for his fractured but the clinical conditions of the patient worse with a poor prognosis so it was decided to transfer to a hospital more complex. Where they performed bronchial biopsy reporting positive for malignancy with histopathologic moderately differentiated squamous cell carcinoma, a bone scan is the same q request could not be performed because the patient died.