Bone lesions can be found in any location of the bone, but every location of the bone has its own lesions. They can also be differentiated by the age or bone type.
DD for Bone Lesions based on the location of the bone
| Bone Section | Lesions |
|---|---|
| Epiphyseal Lesions | â– Chondroblastoma (ages 10-25) â– Giant cell tumor (ages 20-40) â– Clear chondrosarcoma (rare) |
| Diaphyseal Lesions | â– Ewing sarcoma (ages 5-25) â– Lymphoma (adult) â– Fibrous dysplasia (ages 5-30) â– Adamantinoma (consider in the tibia) â– Histiocytosis (ages 5-30) |
| Spine Lesions | Older than 40 Years: â– Metastases â– Multiple myeloma â– Hemiangioma â– Chordoma (in sacrum) Younger than 30 Years: â– Vertebral body â– Histiocytosis â– Hemangioma â– Posterior elements â– Osteoid osteoma â– Osteoblastoma â– Aneurysmal bone cyst |
| Multiple Lesions | â– Histiocytosis â– Enchondroma â– Osteochondroma â– Fibrous dysplasia â– Multiple myeloma â– Metastases â– Hemangioma â– Infection â– Hyperparathyroidism |
Differential Diagnosis for Bone Lesions based on the bone type
| Bone | Lesions |
|---|---|
| Sacrum in young patients (10-40) | – Giant cell tumor – ABC – Ewing’s – Osteosarcoma |
| Sacrum in older patients (40-80) | – Chordoma – Metastasis – Myeloma – Lymphoma – Chondrosarcoma – MFH |
| Tibial lesions | – Adamantinoma – Osteofibrous dysplasia – Fibrous dysplasia – Osteomyelitis |
| Hand and Foot Intramedullary destructive lesions | – Enchondroma – Giant cell tumor – ABC – Giant cell reparative granuloma – Metastatic carcinoma (only in older patients) |
Differential Diagnosis for Bone Lesions based on age
| Age | Benign Lesions | Malignant Lesions |
|---|---|---|
| Infants and children (0 to 5 years) | – Osteomyelitis – Osteofibrous dysplasia | – Metastatic rhabdomyosarcoma – Metastatic neuroblastoma – Leukemia |
| Young patient (10-40 years) | – NOF – Osteoid osteoma – Giant cell tumor – ABC – UBC – Osteochondroma & MHE – Chondroblastoma – Fibrous dysplasia – Osteomyelitis – Eosinophillic granuloma | – Osteosarcoma – Ewing’s – Desmoplastic fibroma – Leukemia – Lymphoma |
| Older patient (40-80 years) | – Enchondroma – Bone infarct – Bone island – Paget’s disease -Hyperparathyroidism | – Metastatic bone disease – Myeloma – Lyphoma – Chondrosarcoma – MFH – Secondary sarcoma (Paget’s, irradiation) |
References & More
- Campbel’s Operative Orthopaedics 12th edition Book.
- Millers Review of Orthopaedics -7th Edition Book.
- Subramanian S, Viswanathan VK. Lytic Bone Lesions. [Updated 2022 Oct 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: Pubmed
- Ewerbeck V, Mau H. Differentialdiagnose der benignen Knochentumoren. Klinik und bildgebende Verfahren [Differential diagnosis of benign bone tumors. Clinical aspects and imaging procedures]. Orthopade. 1995 Feb;24(1):15-23. German. PMID: 7892002.
