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Bone tumor mimickers: A pictorial essay.

Mhuircheartaigh JN, Lin YC, Wu JS - Indian J Radiol Imaging (2014)

Bottom Line: These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes.It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup.Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.

ABSTRACT
Focal lesions in bone are very common and many of these lesions are not bone tumors. These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes. Many of these tumor mimickers can be left alone, while others can be due to a significant disease process. It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup. Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety.

No MeSH data available.


Related in: MedlinePlus

Osteomyelitis with Brodie's abscess. A 29 year old female with left lower leg pain. (A) AP radiograph of ankle demonstrates a faint radiolucency (arrow) in the distal tibial diaphysis (B) Coronal CT image shows that the lesion (arrow) is well demarcated with a non-sclerotic rim (C) Sagittal T2W fat-saturated MRI image shows the hyperintense intraosseous abscess (arrow) with surrounding marrow edema (arrowheads)
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Figure 22: Osteomyelitis with Brodie's abscess. A 29 year old female with left lower leg pain. (A) AP radiograph of ankle demonstrates a faint radiolucency (arrow) in the distal tibial diaphysis (B) Coronal CT image shows that the lesion (arrow) is well demarcated with a non-sclerotic rim (C) Sagittal T2W fat-saturated MRI image shows the hyperintense intraosseous abscess (arrow) with surrounding marrow edema (arrowheads)

Mentions: In acute osteomyelitis, the radiographic findings include areas of aggressive periostitis, cortical destruction, endosteal scalloping, and intracortical tunneling. There may be soft tissue swelling or gas formation. However, the radiographic findings may not be present for 1-2 weeks. MRI and technetium-99 m pyrophosphate bone scintigraphy (bone scintigraphy) are more sensitive in the detection of early osteomyelitis.[43] Subacute or chronic osteomyelitis can cause an intraosseous abscess (Brodie's abscess), commonly in the metaphysis of tubular bones [Figure 22]. On radiographs, these lesions appear as single or multilobulated radiolucent lesions with surrounding sclerosis that fades toward the periphery. These lesions can mimic an osteoid osteoma or osteosarcoma.[44] Lesions without significant sclerosis can mimic Langerhans cell histiocytosis, chondroblastoma, giant cell tumor, and Ewing's sarcoma. CT can be helpful to delineate a sinus tract extending away from the central abscess, excluding other lesions.[45] Systemic signs of infection can be helpful; however, several of the lesions listed in the differential can also present with fever, pain, and other clinical signs of infection. Bone biopsy is often necessary for diagnosis and to identify an organism to guide appropriate antibiotic therapy.[43]


Bone tumor mimickers: A pictorial essay.

Mhuircheartaigh JN, Lin YC, Wu JS - Indian J Radiol Imaging (2014)

Osteomyelitis with Brodie's abscess. A 29 year old female with left lower leg pain. (A) AP radiograph of ankle demonstrates a faint radiolucency (arrow) in the distal tibial diaphysis (B) Coronal CT image shows that the lesion (arrow) is well demarcated with a non-sclerotic rim (C) Sagittal T2W fat-saturated MRI image shows the hyperintense intraosseous abscess (arrow) with surrounding marrow edema (arrowheads)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126137&req=5

Figure 22: Osteomyelitis with Brodie's abscess. A 29 year old female with left lower leg pain. (A) AP radiograph of ankle demonstrates a faint radiolucency (arrow) in the distal tibial diaphysis (B) Coronal CT image shows that the lesion (arrow) is well demarcated with a non-sclerotic rim (C) Sagittal T2W fat-saturated MRI image shows the hyperintense intraosseous abscess (arrow) with surrounding marrow edema (arrowheads)
Mentions: In acute osteomyelitis, the radiographic findings include areas of aggressive periostitis, cortical destruction, endosteal scalloping, and intracortical tunneling. There may be soft tissue swelling or gas formation. However, the radiographic findings may not be present for 1-2 weeks. MRI and technetium-99 m pyrophosphate bone scintigraphy (bone scintigraphy) are more sensitive in the detection of early osteomyelitis.[43] Subacute or chronic osteomyelitis can cause an intraosseous abscess (Brodie's abscess), commonly in the metaphysis of tubular bones [Figure 22]. On radiographs, these lesions appear as single or multilobulated radiolucent lesions with surrounding sclerosis that fades toward the periphery. These lesions can mimic an osteoid osteoma or osteosarcoma.[44] Lesions without significant sclerosis can mimic Langerhans cell histiocytosis, chondroblastoma, giant cell tumor, and Ewing's sarcoma. CT can be helpful to delineate a sinus tract extending away from the central abscess, excluding other lesions.[45] Systemic signs of infection can be helpful; however, several of the lesions listed in the differential can also present with fever, pain, and other clinical signs of infection. Bone biopsy is often necessary for diagnosis and to identify an organism to guide appropriate antibiotic therapy.[43]

Bottom Line: These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes.It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup.Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.

ABSTRACT
Focal lesions in bone are very common and many of these lesions are not bone tumors. These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes. Many of these tumor mimickers can be left alone, while others can be due to a significant disease process. It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup. Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety.

No MeSH data available.


Related in: MedlinePlus