Atypical presentation of bronchogenic carcinoma with humeral metastasis

Bronchogenic carcinoma often manifests with some atypical symptoms which delay the diagnosis of malignancy. The primary manifestation of lung cancer with pathological fracture of humerus due to skeletal metastasis is very rare. We hereby report such a case in an elderly nonsmoker male who initially presented with nontraumatic painful swelling of right arm which was found to be due to humeral fracture. However, initial management by the orthopedic surgeon over 3 months did not provide adequate relief. On subsequent evaluation, chest X-ray showed a right hilar mass. Further radiologic imaging and a guided biopsy from lung mass confirmed an adenocarcinoma. Fine needle aspiration from humeral osteolytic lesion also confirmed metastatic deposit. This case highlights the importance of suspecting pathological fracture while dealing with nontraumatic fracture, especially in elderly patients, which avoids the diagnostic delay.