Causes of Solitary sclerotic bone lesion

Causes of Solitary sclerotic bone lesion

Most common

  • 1. Bone island (enostosis) —ovoid with long axis parallel to long axis of bone and a feathered border.
  • 2. Enchondroma —confluent punctate or nodular calcification, denser centrally than peripherally. Enchondromas in the large long bones are often more calcified than those in the fingers.
  • 3. Metastasis —prostate, breast, mucinous adenocarcinoma of GI tract, carcinoid, lymphoma, TCC in adults. Medulloblastoma and neuroblastoma in children.
  • 4. Callus —usually associated with a fusiform swelling in long bones.
  • 5. Bone infarct —usually a central metadiaphyseal lucency with thin serpentine calcified margins.

Less common

  • 6. Paget’s disease —blastic phase causes sclerosis accompanied by bone expansion, and cortical and trabecular thickening.
  • 7. Osteoma —arises from membranous bone: skull and paranasal sinuses. Ivory osteomas contain no trabeculae. Mature osteomas have visible marrow. If multiple consider Gardner syndrome.
  • 8. Osteoid osteoma/osteoblastoma —sclerosis caused by eccentric periosteal thickening. Osteoid osteoma: radiolucent nidus <2 cm. Osteoblastoma: more common in the posterior elements of spine, larger nidus with thin shell.
  • 9. Healed or healing bone lesion —treated metastasis, NOF, simple bone cyst, brown tumour, eosinophilic granuloma.
  • 10. Primary bone sarcoma —aggressive features: poorly defined margins, aggressive periosteal reaction, Codman’s triangles, bone destruction, soft tissue mass.
  • 11. Fibrous dysplasia —usually lytic with ground glass areas but can calcify in later life.
  • 12. Chronic osteomyelitis —usually associated with an area of lysis, chronic periosteal reaction and occasionally a sequestrum.
  • 13. Chronic recurrent multifocal osteomyelitis (CRMO) —idiopathic inflammatory disorder. Most commonly affects clavicles and tibias in children. Often multifocal.
  • 14. Lymphoma —primary bone lymphoma rare. More common as secondary involvement. Large extraosseous soft tissue mass with relative preservation of bone.
  • 15. Cement and bone graft substitutes —history of surgery.

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