Question

A 44-year-old man presents with insidious and atraumatic proximal lower leg pain. It is more tender during rest than exercise. It commonly occurs at night, and doesn't seem to improve with oral analgesics. Knee testing is negative for meniscal or ligamentous injury. A screening radiograph reveals no fracture, but does show a non-speckled calcified lesion within the proximal tibia. A bone scan shows no spine or pelvic lytic lesions. Which of the following is the most likely diagnosis?

A Chondrosarcoma
B Enchondroma
C Multiple myeloma
D Osteoid osteoma"

Answer 1

The most likely diagnosis for a 44-year-old man with insidious, atraumatic lower leg pain that is worse at rest and during the night, along with a radiograph showing a calcified lesion in the proximal tibia, is Osteoid osteoma.

Step-by-step explanation:

The patient described in the question presents with proximal lower leg pain that worsens during rest and commonly occurs at night. The screening radiograph showing a calcified lesion within the proximal tibia, in conjunction with the patient's symptoms and a bone scan that does not reveal any lytic lesions in the spine or pelvis, suggest Osteoid osteoma as the most likely diagnosis. This benign bone tumor is known for causing pain that is typically worse at night and responds to NSAIDs, which differs from the patient's experience of no relief with oral analgesics, leading to consideration of other potential causes for the pain. However, it still remains the most likely diagnosis based on the radiographic findings and clinical presentation.