Image Quiz
Pathologic Fracture of the Humerus During Pregnancy1
A forty-one-year-old woman experienced progressive discomfort of the right arm, the lower back, and the pelvis during the second trimester of pregnancy. Ovulation had been pharmacologically induced, but the pregnancy had been obstetrically uncomplicated otherwise. The symptoms in the right arm acutely worsened at twenty-eight weeks of gestation when the patient reached to grab a falling object. Plain radiographs of the right arm and forearm were made.
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Fig. 1-B |
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Laboratory studies demonstrated severe anemia, with a hemoglobin level of 74 g/L (normal, 120 to 160 g/L); abnormal renal function, with a serum urea nitrogen level of 33 mg/dL (11.8 mmol/L) (normal, 8 to 25 mg/dL [2.9 to 8.9 mmol/L]) and a serum creatinine level of 2.8 mg/dL (248 µmol/L) (normal, 0.6 to 1.5 mg/dL [53 to 133 µmol/L]); and hypercalcemia, with a serum calcium level of 11.6 mg/dL (2.89 mmol/L) (normal, 8.5 to 10.5 mg/dL [2.12 to 2.62 mmol/L]). The serum and urine protein electrophoresis studies both revealed moderate to large amounts of lambda light chains.
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