An unusual case of forearm swelling

摘要

A 75-year-old woman presented with gradually increasing painless deformity of the left forearm. Physical examination revealed diffuse bony enlargement of the left forearm with a visible radial deformity. Radiographs of the forearm show bowing of the left radius. There was diffuse cortical thickening, bony expansion, and coarsening of the trabecular pattern of the radius and the visualized portion of the distal humerus (Figure). The left ulna and the right forearm appeared normal. The patient's serum alkaline phosphatase was elevated at 448 IU/L. The patient had a history of Paget disease involving the skull and bilateral femurs. Involvement of the pelvis, spine, lower extremities, and skull is commonly seen with Paget disease of the bone. Upper-extremity involvement is unusual,1 and bowing of the upper extremities is rarely seen, presumably because of minimal weight-bearing forces.