Multiple Lucent Bone Lesions

Question 1

Ddx for multiple lucent bone lesions (Mnemonic “Metastases may eventually fracture bones”)

Answer 1

Metastases
Myeloma
Enchondromatosis (Ollier’s Disease/Mafucci Syndrome)
Fibrous Dysplasia
Brown tumors

Question 2

Metastases

Answer 2

Generally occurs in those aged >40 years old
Variable appearances
Well or ill-defined but look for aggressive features
Non-expansile or expansile
May have a sclerotic component

Question 3

Multiple Myeloma

Answer 3

Occurs in those aged >35 years old
Well-defined lytic lesions of uniform size
Endosteal scalloping (non-specific)
Rarely sclerotic

Question 4

Enchondromatosis

Answer 4

Present in childhood
Commonly in hands and wrists
Multiple lytic, expansile, metaphyseal lesions
Chondroid matrix (punctate/curvilinear foci of calcification within lesion)
Abnormal growth, shortening and deformity of affected limbs

Ollier’s disease: many enchondromata

Mafucci’s syndrome: many enchondromata associated with soft tissue
haemangiomas (phleboliths seen on plain film)

Question 5

Fibrous Dysplasia

Answer 5

Occurs in those aged <30 years old
Especially ribs, pelvis and proximal femur, humerus, skull and mandible
Diaphyseal or metaphyseal
Usually well defined
Endosteal scalloping
Hazy, ground-glass internal matrix
Thick sclerotic rim (“rind” sign)
“Shepherd’s crook” deformity – bowed proximal femur

Question 6

Brown Tumors