BMJ Case Reports 2018; doi:10.1136/bcr-2017-224061
  • Images in…

What does vanishing bone disease look like?

  1. James T Patton1
  1. 1Orthopaedic, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Jarrad Stevens, drjarradstevens{at}
  • Accepted 10 March 2018
  • Published 22 March 2018


A previously healthy 44-year-old female presented with an acute history of increasing pain and reduced range of movement in her left shoulder. MRI scan revealed an infiltrative lesion in the proximal humerus, with a degree of cortical thinning and soft tissue involvement; however, initial biopsy provided no definitive diagnosis. Due to the suspicion of underlying malignancy, additional biopsies were organised. A second biopsy provided no diagnosis; however, a third biopsy taken 2 months after presentation revealed a benign vascular lesion with callus formation. This was consistent with the suspicion of our radiologist that a pathological fracture of the proximal humerus had been sustained following a minor fall (figure 1).

Figure 1

Radiograph of left humerus and shoulder at presentation.

Twelve months after presentation, with continued pain and swelling in the arm, further investigations were carried out. Radiographs demonstrated a second pathological fracture of the left proximal humerus, with intramedullary and subcortical radiolucent …

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