6 bubbly lesions of bone

CLINICAL IMAGAGING�AN ATLAS OF DIFFERENTIAL DAIGNOSIS�EISENBERG

1. 6 Bubbly Lesions of Bone

2. CLINICAL IMAGAGING AN ATLAS OF DIFFERENTIAL DAIGNOSIS EISENBERG DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

3. Fig B 6-1 Fibrous dysplasia. Views of (A) the humerus and (B) the ischium in two different patients show expansile lesions containing irregular bands of sclerosis, giving them a multilocular appearance.

4. Fig B 6-2 Giant cell tumor of the distal femur. Typical eccentric lucent lesion in the metaphysis extends to the immediate subarticular cortex. The surrounding cortex, though thinned, remains intact.

5. Fig B 6-3 Malignant giant cell tumor. The tumor has caused cortical disruption, extends outside the host bone, and has an ill-defined margin.

6. Fig B 6-4 Fibrous cortical defect. Multilocular, eccentric lucency in the distal tibia. Note the thin, scalloped rim of sclerosis.

7. Fig B 6-5 Nonossifying fibroma. Multilocular, eccentric lucency with a sclerotic rim in the distal femur.

8. Fig B 6-6 Simple bone cyst in the proximal humerus. The cyst has an oval configuration, with its long axis parallel to that of the host bone. Note the thin septa that produce a multiloculated appearance.

9. Fig B 6-7 Fallen fragment sign. After pathologic fracture, a cortical bone fragment (arrow) lies free in a subtrochanteric bone cyst. 12

10. Fig B 6-8 Aneurysmal bone cyst of the tibia. Expansile, eccentric, cystic lesion with multiple fine internal septa. Because the severely thinned cortex is difficult to detect, the tumor resembles a malignant process.

11. Fig B 6-9 Enchondroma . (A) Well-demarcated tumor (arrow) expands the bone and thins the cortex. (B) Pathologic fracture (arrow).

12. Fig B 6-10 Multiple enchondromatosis . View of both hands demonstrates multiple globular and expansile lucent filling defects involving all the metacarpals and the proximal and middle phalanges.

13. Fig B 6-11 Central chondrosarcoma. Irregular and ill-defined lytic lesion of the lower ilium.

14. Fig B 6-12 Brown tumors. Multiple lytic lesions (A) in the pelvis and (B) about the knee.

15. Fig B 6-13 Solitary plasmacytoma of the ilium (arrows). Some residual streaks of bone remain in this osteolytic lesion, producing a soap-bubble appearance.

16. Fig B 6-14 Solitary plasmacytoma . Highly destructive tumor that has obliterated virtually all of the left half of the pelvis.

17. Fig B 6-15 Renal cell carcinoma metastatic to bone. Typical expansile bubbly lesion (arrows) in the proximal shaft of the radius.

18. Fig B 6-16 Metastatic thyroid carcinoma. Large area of entirely lytic, expansile destruction (arrows) involves the left ilium.

19. Fig B 6-17 Lymphoma. There is a focal lytic defect with endosteal scalloping of the cortex.

20. Fig B 6-18 Langerhans cell histiocytosis. Bubbly osteolytic lesion in the femur, with scalloping of the endosteal margins and a thin layer of periosteal response.

21. Fig B 6-19 Osteoblastoma. Expansile, eccentric mass in the proximal humerus causes thinning of the cortex (arrows).

22. Fig B 6-20 Chondroblastoma. Osteolytic lesion containing calcification (arrows) in the epiphysis. Note the open epiphyseal line. 13

23. Fig B 6-21 Chondromyxoid fibroma. Ovoid, eccentric metaphyseal lucency with thinning of the overlying cortex and a sclerotic inner margin.

24. Fig B 6-22 Intraosseous ganglion cyst. Lucent lesion with sclerotic margin (arrow) in the medial malleolus. 14

25. Fig B 6-23 Coccidioidomycosis. Typical well- marginated , punched-out lytic defect in the head of the third metacarpal (arrows). 15

26. Fig B 6-24 Hemophilia. (A) Large subchondral cysts about the elbow. (B) Destructive, expansile lesion of the lower tibial shaft. 16

27. Fig B 6-25 Hemangioendothelioma . Expansile lucency containing delicate bony trabeculation.

28. Fig B 6-26 Cystic angiomatosis. Lytic lesion in the proximal left humerus (arrow) with relatively well-defined lobular margins and minimal marginal sclerosis. Additional lytic lesions (arrowheads) are in the midhumeral diaphysis. Multiple lesions were seen elsewhere in the axial and proximal appendicular skeleton. 17

29. Fig B 6-27 Sarcoidosis. Multiple osteolytic lesions throughout the phalanges, having a typical punched-out appearance. The apparent air density in the soft tissues is a photographic artifact.

30. Fig B 6-28 PVNS. Large lucent lesion (arrowheads) in the proximal tibia extending to the articular surface, mimicking a giant cell tumor. 14