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A 93-year-old man with known Alzheimer dementia has his admission physical examination on transfer to a geropsychiatric hospital unit due to behavioral difficulties. A language barrier and his stoicism minimize communication, but his devoted wife translates and recounts that he is not in any physical discomfort. Has sometimes needed oxygen treatment in the past.
Somewhat overweight man who appears a few years younger than stated age, affable but usually silent although he understands more English than he lets on. Breath sounds normal. Range of motion of upper limbs mildly reduced to a degree typical for age. Two hemispheric bumps on back feel utterly soft. Neither is fixed to overlying skin nor to chest wall. Small vertically aligned area of firmer tissue abuts medial margin of left-sided mass. No bruit audible over either. Bumps are distinct from scapulae, which move normally.
What's Your Diagnosis? (Answer on next page)
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