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Case 45: cystic angiomatosis.

A 38-year-old woman, in otherwise excellent health, had a 4-year history of left lateral chest wall pain. Physical examination demonstrated a nontender rib cage with normal respiratory movement. Radiographs of the left ribs were obtained (Fig 1). A triple-phase whole-body bone scan demonstrated focal increased uptake within the left sixth rib and right renal enlargement, with no other abnormalities. One year later, the patient had increased left-sided rib pain after an embrace from her husband. A follow-up rib series demonstrated no apparent change. Computed tomography (CT) of the left ribs was performed (Fig 2). A repeat bone scan demonstrated interval decrease in the focal uptake within the left sixth rib and an enlarged distorted right kidney. A radiographic bone survey was performed (Figs 3, 4). Similar findings were also seen in the contralateral humerus, thoracolumbar spine, and pelvis. Subsequent contrast material– enhanced CT of the abdomen was performed (Fig 5). Results of all laboratory tests, including those of serum and urine electrophoresis, did not disclose any abnormalities. CT-guided percutaneous biopsy of a pelvic bone lesion was performed (Fig 6).