An Adolescent With Pain In Her Shoulder

A 14-year-old girl was brought in to her pediatrician for evaluation of a 3-month history of right shoulder pain, which had become particularly uncomfortable over the previous 2 weeks. Despite being a competitive wrestler at her high school, she denied history of acute trauma to the joint and reiterated the progressive, dull, burning nature of the pain. She also denied any fever, chills, and fatigue. There was no family history of arthritis. Physical examination revealed a bony swelling over the right distal clavicle, which was tender to palpation with no overlying erythema.  A radiograph of her right shoulder was performed.

Follow-up magnetic resonance imaging (MRI) scans showed a multiloculated lesion with fluid levels expanding the distal diaphysis of the clavicle and demonstrated enhancement peripherally in the lesion’s thin walls and within its thin septations. No solid intralesional enhancement was seen. However, a small, nodular, enhancing soft-tissue component extending beyond the cortex was seen in some images. Mild edema, likely reactive, was seen in the adjacent subclavius and anterior distal trapezius.

What is your diagnosis?

A. Aneurysmal bone cyst
B. Cystic fibrous dysplasia
C. Eosinophilic granuloma
D. Telangiectatic osteosarcoma