← All patterns
Lytic bone lesion
MSKRadiograph / CT / MRI
A radiolucent bone lesion. Patient age is the single most useful discriminator; zone of transition and periosteal reaction indicate aggressiveness.
Differential
Metastasis / myeloma
common- •Age >40 y, multiple lesions
- •Permeative destruction; myeloma "punched-out" without sclerotic rim
- •Known primary or paraproteinaemia
Simple (unicameral) bone cyst
common- •Central, geographic, mildly expansile in a child
- •Metaphysis of proximal humerus/femur; fallen-fragment sign
Giant cell tumour
less-common- •Eccentric, subarticular extending to the articular surface
- •Closed physis (20–40 y); narrow zone of transition, no rim
Aneurysmal bone cyst
less-common- •Expansile, multiple fluid–fluid levels on MRI
- •Eccentric metaphyseal; <20 y
Fibrous dysplasia
less-common- •Ground-glass matrix with a sclerotic ("rind") margin
- •Diaphyseal/metadiaphyseal; no periosteal reaction
Chondrosarcoma
rare- •Chondroid rings-and-arcs matrix with endosteal scalloping
- •Older adult; deep pain, cortical breach
Key discriminators
- •Patient age (single best discriminator)
- •Zone of transition (narrow benign vs wide/permeative aggressive)
- •Matrix (chondroid rings-and-arcs vs ground-glass)
- •Location within bone (epiphysis/metaphysis/diaphysis; central vs eccentric)
- •Periosteal reaction and cortical integrity
Work-up / next steps
- 1.Radiograph first to assess matrix, margin and periosteal reaction
- 2.MRI for marrow extent and soft-tissue component
- 3.Skeletal survey / whole-body imaging and myeloma screen if multiple
- 4.Biopsy at a bone-tumour centre for aggressive lesions
References
- Radiopaedia: Lytic bone lesion.
- Miller TT. Bone tumors and tumor-like conditions. Radiology.
Educational clinical decision support only. This differential does not make a diagnosis, is not a medical device, and must never substitute for interpretation by a qualified radiologist correlated with the full clinical picture and prior imaging.