Approach to a suspected bone tumor (pediatrics) Quiz: Ace Your Exams

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A 16-year-old boy comes to the pediatric clinic because of several weeks of dull localized left upper arm pain that is worse at night. He has not had recent trauma and has not done any strenuous physical activity recently. He has no fever or weight loss. He has no significant past medical history and does not take any medication. Temperature is 37.0 ºC (98.6 ºF), heart rate is 90/min, respiratory rate is 14/min, and blood pressure is 110/68 mmHg. He is well-appearing, comfortable, and not in acute pain. Physical examination reveals a large, tender, palpable soft tissue mass in the left proximal upper arm. Plain radiographs of the left arm are ordered. Which of the following imaging findings would be the most concerning for malignancy?  

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