Intended for healthcare professionals

Endgames Spot diagnosis

A painless lump in the arm

BMJ 2016; 354 doi: (Published 13 September 2016) Cite this as: BMJ 2016;354:i4503
  1. Shahrukh Raees Ahmad, foundation year 2 doctor1,
  2. Raees Bhatti, 4th year medical student2,
  3. Gulraiz Ahmad, radiology registrar3
  1. 1Pennine Acute Hospitals NHS Trust, Manchester, UK
  2. 2University of Liverpool, UK
  3. 3North West School of Radiology
  1. Correspondence to: S R Ahmad shahrukh.ahmad{at}

A 15 year old boy presented to his doctor with a painless palpable lump in his right upper arm. He had had it for “many years,” but was now conscious about it. A plain radiograph of the arm showed multiple bony lesions (fig 1). What is the diagnosis?

Fig 1 Anteroposterior radiograph of right upper arm


Hereditary multiple exostoses (also known as diaphyseal aclasis) (fig 2).

Fig 2 Anteroposterior radiograph of right upper arm. Osteochondromas can …

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