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Radiology
Benign Lucent Bone Lesions
Built from Fundamentals of Diagnostic Radiology
What’s inside
5 sections · 98 slides
Overview
- Benign Lucent Bone Lesions
Approaching a lucent bone lesion
Confirm the lesion is benign, then let FEGNOMASHIC drive a short, accurate list
- How to approach a benign lucent lesion
- A common skeletal finding
- Pattern recognition and its limits
- A mnemonic makes the list recallable
- “
- FEGNOMASHIC expands — F through O
- FEGNOMASHIC expands — M through C
- Discriminators for benign lucent bone lesions
- Discriminators for benign lucent bone lesions (continued)
The fifteen FEGNOMASHIC lesions
What each lesion looks like, and the one or two keys that set it apart
- Fibrous dysplasia — the great mimic
- Fibrous dysplasia — where it grows
- Fibrous dysplasia of the pelvis and proximal femurs
- Fibrous dysplasia of the right femur and ilium
- Monostotic fibrous dysplasia of the femoral neck
- Fibrous dysplasia of the posterior ribs and spine
- Polyostotic fibrous dysplasia of the radius in a child
- Fibrous dysplasia — tibia look-alikes and syndromes
- Adamantinoma of the tibial midshaft
- Enchondroma — the cartilage lesion
- Enchondroma of the phalanges with pathologic fracture
- Enchondroma of the distal femur with chondroid matrix
- Enchondroma — infarct, sarcoma, and syndromes
- Bone infarcts of the distal femurs
- Ollier disease: multiple enchondromas of the hand
- Maffucci syndrome: enchondromas and phleboliths
- Eosinophilic granuloma — protean and young
- Eosinophilic granuloma of the mid-femur
- Polyostotic eosinophilic granuloma of the pelvis
- Eosinophilic granuloma — sequestrum and mimicry
- Eosinophilic granuloma with a bony sequestrum
- Giant cell tumor — nature and outcome
- Four criteria for giant cell tumor
- Giant cell tumor — applying the rules
- Giant cell tumor of the distal femur
- Giant cell tumor of the greater trochanter
- Giant cell tumor of the iliac wing
- Nonossifying fibroma — the most common lesion
- Fibrous cortical defect of the medial tibia
- Nonossifying fibroma of the distal tibia
- Nonossifying fibroma — how to recognize it
- Nonossifying fibroma of the distal fibula
- Nonossifying fibroma: apparent cortical destruction on CT
- Nonossifying fibroma — healing and pitfalls
- Healing nonossifying fibroma of the proximal humerus
- Large nonossifying fibroma of the distal femur
- Osteoblastoma — rare ABC mimic
- Osteoblastoma of the T12 posterior elements
- Metastatic disease — a benign look is possible
- Renal metastasis with a benign appearance
- Expansile renal cell metastasis of the radius
- Myeloma and plasmacytoma
- Multiple myeloma: permeative femur and skull lesions
- Plasmacytoma of the ilium
- Plasmacytoma of L5 with mini-brain appearance
- Aneurysmal bone cyst — expansile by name
- Aneurysmal bone cyst of the distal femur
- Aneurysmal bone cyst of the ulnar midshaft
- Aneurysmal bone cyst with fluid-fluid levels
- Solitary bone cyst — always central
- Solitary bone cyst of the proximal femur
- Solitary bone cyst — fallen fragment and sites
- Solitary bone cyst of the proximal humerus with fallen fragment sign
- Solitary bone cyst of the calcaneus
- Brown tumors of hyperparathyroidism
- Brown tumors of the hand in hyperparathyroidism
- Cystic angiomatosis — multiple hemangiomas
- Cystic angiomatosis of the pelvis and femurs
- Osteomyelitis — no reliable exclusion
- Brodie abscess of the proximal humerus
- Osteomyelitis with a bony sequestrum
- Chondroblastoma — epiphyseal and young
- Chondroblastoma of the greater tuberosity
- Geode — a benign epiphyseal mimic
- Geode of the proximal humerus with degenerative disease
- Chondromyxoid fibroma — NOF look-alike
- Chondromyxoid fibroma of the distal tibia
Narrowing the differential
Age, site, pain, and lesion number shrink FEGNOMASHIC to a short list
- Keys that narrow the list
- Narrowing by age
- Lesions in patients younger than 30 years of age
- Automatics — mention them every time
- Automatics
- Pain and periostitis shorten the list
- Lesions that have no pain or periostitis
- Epiphyseal lesions
- Epiphyseal lesions
- Rib lesions — the FAME mnemonic
- Differential for rib lesions (FAME)
- Multiple lesions — the FEEMHI mnemonic
- Multiple lesions (FEEMHI)
- Findings that do not narrow the list
- Calcified matrix — be careful
Sclerotic look-alikes
When a lucent lesion heals, it can become a sclerotic focus
- When a lucent lesion heals into sclerosis
- Healing nonossifying fibroma of the proximal tibia
- Giant bone island of the supra-acetabular ilium
- Summary — a working differential
- References
- Brant and Helms' Fundamentals of Diagnostic Radiology