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Causes of Bone sclerosis with a periosteal reaction
Most common
- 1. Healing fracture .
- 2. Metastasis —osteoblastic metastases from prostate.
- 3. Osteoid osteoma/osteoblastoma —solid or lamellated periosteal reaction.
- 4. Chronic osteomyelitis —look for sequestrum.
- 5. Osteosarcoma —classically sunray spiculation.
Less common
- 6. Ewing sarcoma —often onion-skin or lamellated periosteal reaction.
- 7. Chondrosarcoma —chondroid matrix with regions of enchondral ossification.
- 8. Lymphoma .
- 9. CRMO —clavicles and tibias in children and adolescents.
- 10. SAPHO syndrome —similar to CRMO but in adults. Although similar long bone changes may be seen, anterior chest wall and pelvic involvement predominate.
- 11. Infantile cortical hyperostosis (Caffey’s disease) —infants <6 months of age. Multiple bones, especially mandible, ribs and clavicles.
Rare
- 12. Melorheostosis —sclerotomal distribution. Cortical and medullary sclerosis likened to dripping candle wax.
- 13. Tertiary syphilis —usually bilateral periostitis involving skull, clavicles, ribs and tibias. Mixed sclerotic and lytic ‘gummatous’ lesions can also be seen.
