Musculoskeletal case 26. Presentation
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* Ciaran Keogh
* William C. Torreggiani
* Khalid Al-Ismail
* Peter L. Munk

A 16-year-old boy complained of a persistent pain in his right thigh. He had first noticed symptoms 6 months earlier. Initially, the pain was intermittent, but at the time of presentation it was continuous and tended to be worse at night. Non-steroidal anti-inflammatory medication provided some relief. Physical examination revealed mild tenderness to palpation of the upper femur but no other finding of note.

A plain radiograph of the femur (Fig. 1) demonstrated cortical thickening and sclerosis of the upper femoral shaft (arrows). Radioisotope bone scanning with 99mTc MDP (technetium 99m methylene diphosphonic acid) was subsequently performed (Fig. 2).

![FIG. 1](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/46/1/52/F1.medium.gif)

[FIG. 1](http://canjsurg.ca/content/46/1/52/F1)

FIG. 1 

![FIG. 2](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/46/1/52/F2.medium.gif)

[FIG. 2](http://canjsurg.ca/content/46/1/52/F2)

FIG. 2 

What is the most likely diagnosis? What other radiologic investigation would help to confirm this?

For the answer see page 62.

## Footnotes

*   Inquiries about this section should be directed to the section editor: Dr. Peter L. Munk, Professor, Department of Radiology, Vancouver General Hospital and Health Sciences Centre, 855 West 12th Ave., Vancouver BC V5Z 1M9; plmunk{at}interchange.ubc.ca