Presentation
6-month history of ankle and shoulder pain. Raised inflammatory markers.
Patient Data
Diffuse smooth periosteal reaction over bilateral distal tibias.
Large lobulated opacity projected over the mediastinum, consistent with a mediastinal mass. This obscures the left heart border in keeping with the anterior mediastinal mass. Additionally, there is a widening of the right paratracheal stripe, likely to represent lymphadenopathy.
CT confirms a large, heterogeneous, lobulated anterior mediastinal mass. This mass is encircling the left brachiocephalic vein without occluding it. The major craniocervical arteries remain patent. Right, paratracheal lymphadenopathy. Clear lungs. There is no sub-diaphragmatic disease.
Pathology:
Mediastinal tissue biopsy is consistent with Hodgkin lymphoma (nodular sclerosing subtype).
Case Discussion
This young adult patient presented with longstanding musculoskeletal pains and raised inflammatory markers as a presentation of lymphoma. Radiographs demonstrated a diffuse periosteal reaction of the tibias in keeping with hypertrophic osteoarthropathy.
Hypertrophic osteoarthropathy is a syndrome characterized by a periosteal reaction of the long bones. It is typically associated with intrathoracic pathology, although lymphoma is a recognized cause, particularly in children and adolescents 1.
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