Preliminary Presentation of Metastatic Non-Small Cell Carcinoma of the Lung as Atraumatic Avulsion Fracture of the Lesser Trochanter

Abstract

Traumatic avulsion fractures of the lesser trochanter are usually seen along with fractures of the proximal femur and with young adolescents involved in high-intensity sporting injuries. Atraumatic isolated lesser trochanter avulsion in adults are most commonly associated with malignancy. We describe a case of a female in her sixties who was previously fit and healthy with no systemic illness and no history of trauma presenting with groin pain. The X-ray demonstrated an isolated lesser trochanter avulsion fracture. Further imaging including MRI and a staging CT scan of the neck, chest, abdomen and pelvis revealed a pulmonary tumour. Biopsy later confirmed this as a non-small cell carcinoma of the lung. At the time of publication, she had been started on palliative chemotherapy (afatinib) with encouraging results. ConclusionsGroin and upper thigh pain in adults without a definitive history of trauma and radiological features suggesting an isolated lesser trochanteric avulsion should raise the suspicion of an infiltrative malignant pathology. MRI scans should be performed to confirm the diagnosis as well as to identify the presence of propagated fracture lines into the trochanteric and subtrochanteric region. A staging CT scan of the chest, abdomen and pelvis is mandatory to find the source of the primary tumour and establish the appropriate treatment protocol for the patient.