RadioGraphics 2009; 29:2184-2189
Daria E. Setlik, MD Kevin M. McCluskey, MD Jeffrey A. McDavit, MD
History: A 75-year-old woman presented with left knee pain and fatigue that had persisted for several months. Before presentation, she was in her usual state of health. She had no history of trauma and had a 20 pack-year history of tobacco use. When conservative treatment failed to resolve symp¬toms, radiography was performed and revealed a lytic lesion in the proximal left tibia. Results of magnetic resonance (MR) imaging confirmed the presence of a large destructive lesion in the proxi¬mal tibia that was suggestive of a metastasis (Fig 1). Additional evaluation with contrast material-enhanced computed tomography (CT) of the ab¬domen and pelvis revealed a/i exophytic right renal mass diat was suggestive of/renal cell carcinoma (RCC) (Fig 2a). Because of the risk for an im¬pending pathologic fracture, the metastatic lesion was resected and the joint was reconstructed with a hinged knee arthroplasty. Before reconstruction, transcatheter embolization of the metastasis was performed to minimize intraoperative blood loss. One month later the patient underwent a partial right nephrectomy and resection of the renal mass.