The following shoulder x-rays are from a 62 year old with a history of renal cell carcinoma. The patient has experienced a minor fall and is complaining of pain in the left shoulder area. What can be noted in the x-rays?

 

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The x-ray does not show any fracture in the upper humerus or clavicle. The shoulder and acromioclavicular joints are normally aligned. However, there is an expansile lytic area with an oblique linear lucency in the inferior aspect of the scapula. This is concerning for an underlying bony lesion with pathological fracture.

A CT scan confirmed the x-ray findings.

 

The classic differential diagnosis for an expansile, lytic metastasis is renal cell or thyroid carcinoma.

Reference: Fundamentals of Diagnostic Radiology by Brant and Helms

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