0:00

So let's unpack.

0:02

The first learning objective so for bone lesions,

0:05

let's discuss the differential diagnosis of conditions affecting

0:08

the biopsy site.

0:10

In the first instance, we need to understand. What is the differential

0:13

diagnosis of an individual presenting with skeletal pain?

0:16

For every time we are asked to perform a

0:19

biopsy, we're not just performing the biopsy. We

0:22

need to understand what other reasons from

0:25

the point that an individual experience is a particular

0:28

symptom exhibits a particular sign to

0:31

the point that we then make a decision to determine that this

0:34

patient is actually appropriate for our biopsy.

0:37

So it's not about just understanding the procedure and the technical

0:40

considerations. It's an understanding the full clinical context.

0:43

So let's unpacked the

0:46

differential diagnosis of scalable pain.

0:48

Of course, we have individuals that can present with infection

0:51

in the case of discitus or

0:54

osteomyelitis. We have individuals that can present with tumors.

0:57

These tumors certainly can be causes for pain and

1:00

tumors are not always malignant in nature. Some of

1:03

them can be benign.

1:04

We have situations where when the patient has a malignant

1:07

tumor. It could be a primary tumor like in the case of obviously primary

1:10

bone tumors or metastatic

1:13

tumor to the

1:16

Bone.

1:16

the case of RCC for example

1:19

In the case of trauma, of course this can

1:22

cause pain and we see an oblique humeral fracture

1:25

certainly painful and then there's systemic

1:28

causes these would be things that are inflammatory nature like

1:31

rheumatoid arthritis tumor inducia. And

1:34

of course Pages disease, which we see here. There

1:37

are degenerative cases where we essentially have

1:40

patients that present with structural Integrity

1:43

issues of the trabecula in the

1:46

case of Austrian necrosis that can be secondary to steroid

1:49

use or sickle cell disease and

1:52

a case of osteoporosis individuals that

1:55

may be postmenopausal decrease mineralization of

1:58

the bone is one of those very clear visualization

2:01

that we see in these particular settings.

2:05

And of course there are nutritional and toxic reasons for skeletal

2:08

pain Ricketts fluorosis and vitamin D

2:11

deficiency being within that category.