An unexpected supraclavicular swelling
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Open Access
Case report
An unexpected supraclavicular swelling Nishith NB Patel, Parin R Shah, Eliie Wilson and Puthcode N Haray* Address: Department of General Surgery, Prince Charles Hospital, Merthyr Tydfil. CF47 9DT, UK Email: Nishith NB Patel - [email protected]; Parin R Shah - [email protected]; Eliie Wilson - [email protected]; Puthcode N Haray* - [email protected] * Corresponding author
Published: 4 August 2007 World Journal of Surgical Oncology 2007, 5:90
doi:10.1186/1477-7819-5-90
Received: 5 February 2007 Accepted: 4 August 2007
This article is available from: http://www.wjso.com/content/5/1/90 © 2007 Patel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Colorectal cancer is the third commonest cause of cancer death in UK. It commonly metastasises to the liver but rarely to small bones. Case presentation: We describe a case of a patient with adenocarcinoma of the descending colon who presented preoperatively with a right supraclavicular swelling. Subsequent imaging and cytology of the lesion revealed this to be a metastasis to the right clavicle resulting in a pathological fracture. Conclusion: This report describes the rare occurrence of a colorectal metastasis to the clavicle. It emphasises that although bone metastases from primary colorectal tumours are rare events, they tend to metastasise to small, non-weight bearing bones. It also discusses the utility of isotope bone scanning and that on certain occasions this imaging method may prove to be equivocal. In such circumstances, biopsy or magnetic resonance imaging is more sensitive for the detection of bone metastases.
Background Colorectal cancer is the third commonest cause of cancer death in the UK. It commonly metastasises to the liver (nearly 50%) [1], the other sites being lung, brain and bones. Metastasis to the clavicle is extremely rare and in this article, we report one such case of an unusual presentation of clavicular metastasis from a primary colonic malignancy not detected on the isotope bone scan.
Case presentation A 68 year old man presented with a change in bowel habit and weight loss. General and abdominal examinations were normal. A barium enema revealed a tight stricture in the descending colon, with no evidence of extra-colonic metastases on a staging CT scan. A multi-disciplinary deci-
sion was taken that he should be treated with a left hemicolectomy. Prior to the operation, he noticed a swelling in the right supraclavicular fossa (figure 1). The swelling was approximately 5 cm in diameter, with a hard consistency, immobile, non-tender, non-fluctuant and clinically appeared to be arising from the clavicle. There was no history of trauma. A plain X-ray showed an osteolytic lesion in the medial aspect of the ri
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