2. Diagnostic Considerations
• Osteomyelitis is a known mimic of various diseases, and subacute
osteomyelitis is no exception, having all of the presenting signs and
symptoms of many bone tumors, both benign and malignant
• Patients with subacute osteomyelitis may occasionally be initially
diagnosed with Ewing sarcoma or osteogenic sarcoma. From these
observations, the following lesions must be considered among the
differential diagnosis of subacute osteomyelitis:
3. • When the lesion is diaphyseal and associated with an onion-skin periosteal
reaction, it may be confused with Ewing sarcoma, Langerhans cell
histiocytosis, or, much less likely, osteogenic sarcoma
• When the lesion is epiphyseal, it may be confused with a chondroblastoma,
fungal osteomyelitis, or tuberculous osteomyelitis, or with an aneurysmal
bone cyst, pigmented villonodular synovitis (PVNS) erosions, giant cell
tumor, or gout, depending upon the age of the patient
• Metaphyseal eccentric lesions may be confused with the more
common nonossifying fibroma, though typically the diagnosis of
nonossifying fibroma is easily made, as is the diagnosis of chondromyxoid
fibroma
• Brodie abscesses, osteoid osteoma, and intracortical hemangioma should
all be included in the differential diagnosis of an intracortical bone lesion
4. Osteoid Osteoma
• a benign bone tumor of undetermined etiology, composed of a
central zone named nidus which is an atypical bone completely
enclosed within a well vascularized stroma and a peripheral sclerotic
reaction zone
• The peripheral sclerotic reaction zone is composed of osteoblasts,
osteoclasts and dilated capillaries surrounding the nidus
• There are three types of radiographic features: cortical, medullary
and subperiosteal
5. Intracortical hemangioma
47-year-old man with intracortical hemangioma. Lateral
radiograph of the right lower leg shows an expansile, lytic lesion
with geographic border at the anterolateral cortex of the distal
tibial diaphysis. There are internal lattice-like, vertically
oriented striations and trabeculae with a minimal, thin,
sclerotic rim and cortical erosion.
Intracortical hemangioma is an extremely uncommon primary
bone tumor
6.
7. Chondroblastoma
• Rare benign cartilaginous neoplasm that characteristically arises in
the epiphysis of a long bone in young patients
• Usia 10 – 20 tahun, laki2 >>
• Eccentric in long bone
• Top five location: femur, humerus, tibia, tarsal bone (calc), patella
• Underexposed radiographs may fail to depict a chondroblastoma. CT
scanning may be useful for the better definition of possible cortical
erosion and matrix mineralization, although this modality is usually
inferior to MRI in the evaluation of transphyseal or transcortical
extension, both of which are important factors in preoperative
planning
8. • The differential diagnosis includes chondrosarcoma, skeletal
eosinophilic granuloma, giant cell tumor, hemangioma of bone,
and osteomyelitis
9. Aneurysmal bone cyst
• a benign but locally aggressive lesion that predominantly afects children
and young adults
• Patients with ABCs typically present with insidious onset of pain, swelling
or a palpable mass
• ABCs can involve every skeletal site, but the most common locations are
the metaphysis of the long
• Typically, ABCs on radiographs are lytic, expansile, geographical,
lobulated, metaphyseal-based lesions and have a distinct sclerotic border
• ABC also has internal septations that may or may not be visible on
radiographs
• The main diferential diagnosis of an ABC in the pediatric population is
unicameral bone cyst (UBC) and telangiectatic osteosarcoma
10.
11. SBC (Simple Bone Cyst)
• Because SBC’s occur in patients whose growth plates are not yet or
recently closed, patients are young (85% <20 years old
• The lesions are usually located in the central metaphysis of long
bones, most often the proximal humerus or femur, although a wide
variety of locations has been described. Involvement of the calcaneus
and/or ilium occurs in adult patients
Uncomplicated SBC's are merely asymptomatic, but occasionally, pain
or stiffness may be present in the adjacent joint
• On conventional radiographs, SBC's present as well-circumscribed,
radiolucent lesions in the central metaphysis, bisa jg di diafisis
12. Giant Cell Tumor
• Usia 20-40 tahun
• The typical appearance is a lytic
lesion with a well-defined but
nonsclerotic margin that is eccentric
in location, extends near the articular
surface, and occurs in patients with
closed physes
• GCT may have aggressive features,
including cortical expansion or
destruction with a soft-tissue
component
13. Osteochondroma
• Plain radiography should be the first imaging modality to assess an
osseous lesion. Typically, osteochondroma presents as a well-defined
protuberance on the external surface of a bone. The lesion varies
from 1 to 10 cm and consists of a cortex and a medulla, which are in
continuity with the underlying bone. It can be either sessile or
pedunculated. If the tumor sticks out from the bone through a stalk,
it is called pedunculated
• They are frequently asymptomatic and have very low malignant
potential if sporadic and solitary
14. Periosteal osteosarcoma
• The radiological appearance of periosteal osteosarcoma have been
reported to present a broad based surface soft tissue mass, leading to
extrinsic erosion of thickened diaphyseal cortex along with periosteal
reaction, which invades into the soft tissue component
• The periosteal reaction is predominantly perpendicular to the diaphyseal
cortex
• Radiography findings include thickening of the diaphyseal cortex with
scalloping and perpendicular periosteal reaction extending into broad
based soft tissue mass
• The most commonly occurring periosteal reaction is non-aggressive, and
solid in nature
• Radiography also reveals the extent of mineralization in to soft tissue mass
(mild, moderate, marked). The maturity and extent of mineralization in the
soft tissue component is also examined by the radiography
