Presenting By- Dr. Golam Muhamud (Suhash).Prepared By-Dr. Md Nazrul IslamMBBS, M .sc. (B M E).
• She has h/o wt. loss, and loss of appetite but she has /had no complaints of pain, swelling and deformity in other parts of the body. She has no history of cough , haemoptysis, DM , HTN and asthma.• With these complaints she got herself admitted into Shaheed Suhrawardy Medical college Hospital for better management.
She had no history of tuberculosis. Drug history:• H/O taking analgesic for 3 months but could not mentioned the name of drugs.
None of her family member suffered fromsuch illness.Personal history:Nothing contributory
• MP-4 to 6 days• MC-regular• Age of menarche-13yrs.
Fluctuation test- negative,Trans-illumination test-negative,Patellar tap test- negative.Shortening of limb - 3 cm.Muscle wasting- Thigh – 4 cm. Leg – 2 cm Distal neurovascular status- normal Regional lympnodesnot enlarged.
Movement: walk with support. Left knee (ROM)– • Active flexion -Absent • Active extension-Absent • Patellar movement-Absent Left hip & ankle: normal range of movement
Locomotor systemGait: Can walk with supportInspection:Flexion attitude- Left knee(20 degree)Palpation: Tenderness – affected area. Spine: Normal
Higher psychic function: NormalCranial Nerve examination: NormalMotor function:Inspection: Gross Muscle wasting in left thigh & leg.
Deep tendon reflex: All jerks are present & normalSensory function test: All the sensory functions are normal.
Inspection: Normal in size & shape of the chest- Respiratory rate: 16 /min Palpation: Trachea centrally placed, normal chest expansibility Percussion: Resonant all over the chest except right upper, middle and lower zone where dullness is present. Auscultation: Bronchial breathing sound with diminished breathing sound in Rt. Upper middle and lower zone.
Pulse: 84 bts/ min B.P. 110/60 mm of Hg JVP: Not raised. Inspection: NAD Palpation: Apex beat in Lt 5thintercostal space, Percussion: superficial cardiac dullness presence over the precordium. Auscultation: s1& s2 is audible
• Inspection: nothing abnormality detected• Palpation: soft, non tender• Percussion: tympanic Auscultation: bowel sound present Per-rectal examination: normal findings.
Ms. Fatema, 18 years ill-looking, moderately anaemic, non icteric, nondiabetic, normotensive woman coming from Mirpur, Dhaka admitted in ShaheedSuhrawardy Medical College Hospital with thecomplaints of –• pain, just above the left knee joint 3 months back ,• swelling above the left knee joint 2 months back and• inability to walk for 1month.
• The pain was initially mild , fixed, non radiating, aching in nature but gradually it becomes intolerable which was aggravated during walking and worse at night & incompletely relived by taking NSAIDs.Thispain was not associated with fever.• She also noticed an ill defined swelling above left knee joint which was initially.
Small in size then it increases rapidly to a large size.It is associated with pain but not related to trauma.• She also gives H/O inability to walk due to pain,swelling and restriction of movement.• She gives H/O wt loss,loss of appetite but she has no H/O pain,swelling,deformity in other parts of body.
• On local examination- an ill defined diffuse swelling occupying over the supracondylar region of the left thigh with shiny skin and presents of engorged vein and wasting of the thigh and leg.• She has a deformity of knee and cannot walk without support.
• The surface of swelling smooth, margin- ill- defined, local temperature-raised , tenderness present, over lying skin is free, consistency-hard, not movable and fixed with underlying structure.• Shortening of the left limb was found 3 cm than the right. She was unable to walk without support.
• There was gross muscle wasting in left Lower limb, measuring thigh- 4cm, leg- 2 cm.• Neuromuscular status of left lower limb normal and regional lympnodes are not enlarged.Movement of the left knee joint absent hip and spine are normal.• On respiratory system examination-there was a dullness in Rt upper and lower zone of lung and breath sound also diminished in same area.Other system examination reveals no abnormality.
• Extensive bone destruction is seen in the left lower femoral shaft, condyles and tibialcondyles with soft tissue extension.• peripheral calcification also seen.• Bone destruction also seen in L5 vertebra.
Multiple metastatic nodules in both lungs along withRt. Sided Hydro-pneumothorax-
S. creatinine 0.6 mg/ dl Blood urea 30 mg / dl S. calcium 7.5 mg / dl S. alkaline phosphates 110 IU/ L SGPT:26 IU/L , SGOT :33 IU/L S. bilirubin:1.0 mg/dl• FNAC- Sarcomatous leison,suggestive of osteosarcoma.• Biopsy (incisional): Feature of osteosarcoma with osteod formation and many giant cells.