Causes of Multiple sclerotic bone lesions

Causes of Multiple sclerotic bone lesions

Most common

  • 1. Metastases —prostate, breast, mucinous adenocarcinoma of GI tract, carcinoid, lymphoma, TCC in adults. Medulloblastoma and neuroblastoma in children.
  • 2. Multiple healed bone lesions —lytic metastases following radiotherapy or chemotherapy. Eosinophilic granulomas and brown tumours following treatment.
  • 3. Paget’s disease —often polyostotic.

Less common

  • 4. Multiple bone infarcts —consider an underlying disorder, e.g. sickle cell or Gaucher disease.
  • 5. Multiple stress fractures —callus formation around fractures.
  • 6. Lymphoma .
  • 7. Osteopoikilosis —multiple symmetrically distributed bone islands in the metaphyses and epiphyses of long bones and the pelvis. Some ovoid, some round.
  • 8. Multifocal osteosarcoma .
  • 9. Multiple osteomas —Gardner syndrome.
  • 10. Fibrous dysplasia —long lesions in long bones, often hemimelic (McCune-Albright syndrome). Usually lytic but can calcify.
  • 11. CRMO and SAPHO .


  • 12. Osteopathia striata (Voorhoeve disease) —linear striations along long axis of long bone.
  • 13. Erdheim-Chester disease —bilateral symmetrical metadiaphyseal sclerosis in long bones, most commonly femora and tibias.
  • 14. Multiple myeloma —sclerotic in 3%.
  • 15. Tuberous sclerosis.
  • 16. Intramedullary osteosclerosis —diaphyseal endosteal sclerosis typically involving the tibia or femur, usually bilateral and in women.

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