This document contains radiographic images and descriptions of various bubbly or lytic bone lesions. It shows examples of lesions caused by conditions such as fibrous dysplasia, giant cell tumor, aneurysmal bone cyst, enchondroma, central chondrosarcoma, plasmacytoma, renal cell carcinoma metastases, lymphoma, Langerhans cell histiocytosis, osteoblastoma, chondroblastoma, intraosseous ganglion cyst, coccidioidomycosis, hemophilia, hemangioendothelioma, cystic angiomatosis, sarcoidosis, and pigmented villonodular synovitis. The images demonstrate the location, appearance,

1. 6Bubbly Lesions of Bone

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig B 6-1 Fibrous dysplasia. Views of (A) the
humerus and (B) the ischium in two different
patients show expansile lesions containing
irregular bands of sclerosis, giving them a
multilocular appearance.

4. • Fig B 6-2 Giant cell tumor of the distal femur.
Typical eccentric lucent lesion in the metaphysis
extends to the immediate subarticular cortex.
The surrounding cortex, though thinned, remains
intact.

5. • Fig B 6-3 Malignant giant cell tumor. The tumor
has caused cortical disruption, extends outside
the host bone, and has an ill-defined margin.

6. • Fig B 6-4 Fibrous cortical defect. Multilocular,
eccentric lucency in the distal tibia. Note the
thin, scalloped rim of sclerosis.

7. • Fig B 6-5 Nonossifying fibroma. Multilocular,
eccentric lucency with a sclerotic rim in the
distal femur.

8. • Fig B 6-6 Simple bone cyst in the proximal humerus.
The cyst has an oval configuration, with its long axis
parallel to that of the host bone. Note the thin septa
that produce a multiloculated appearance.

9. • Fig B 6-7 Fallen fragment sign. After pathologic
fracture, a cortical bone fragment (arrow) lies
free in a subtrochanteric bone cyst.12

10. • Fig B 6-8 Aneurysmal bone cyst of the tibia. Expansile,
eccentric, cystic lesion with multiple fine internal
septa. Because the severely thinned cortex is difficult
to detect, the tumor resembles a malignant process.

11. • Fig B 6-9 Enchondroma. (A) Well-demarcated
tumor (arrow) expands the bone and thins the
cortex. (B) Pathologic fracture (arrow).

12. • Fig B 6-10 Multiple enchondromatosis. View
of both hands demonstrates multiple globular
and expansile lucent filling defects involving
all the metacarpals and the proximal and
middle phalanges.

13. • Fig B 6-11 Central chondrosarcoma. Irregular
and ill-defined lytic lesion of the lower ilium.

14. • Fig B 6-12 Brown tumors. Multiple lytic lesions
(A) in the pelvis and (B) about the knee.

15. • Fig B 6-13 Solitary plasmacytoma of the ilium
(arrows). Some residual streaks of bone remain in
this osteolytic lesion, producing a soap-bubble
appearance.

16. • Fig B 6-14 Solitary plasmacytoma. Highly
destructive tumor that has obliterated
virtually all of the left half of the pelvis.

17. • Fig B 6-15 Renal cell carcinoma metastatic to
bone. Typical expansile bubbly lesion (arrows) in
the proximal shaft of the radius.

18. • Fig B 6-16 Metastatic thyroid carcinoma. Large
area of entirely lytic, expansile destruction
(arrows) involves the left ilium.

19. • Fig B 6-17 Lymphoma. There is a focal lytic
defect with endosteal scalloping of the cortex.

20. • Fig B 6-18 Langerhans cell histiocytosis. Bubbly osteolytic
lesion in the femur, with scalloping of the endosteal
margins and a thin layer of periosteal response.

21. • Fig B 6-19 Osteoblastoma. Expansile, eccentric
mass in the proximal humerus causes thinning
of the cortex (arrows).

22. Fig B 6-20 Chondroblastoma. Osteolytic lesion containing
calcification (arrows) in the epiphysis. Note the open epiphyseal
line.13

23. • Fig B 6-21 Chondromyxoid fibroma. Ovoid,
eccentric metaphyseal lucency with thinning
of the overlying cortex and a sclerotic inner
margin.

24. • Fig B 6-22 Intraosseous ganglion cyst. Lucent
lesion with sclerotic margin (arrow) in the
medial malleolus.14

25. • Fig B 6-23 Coccidioidomycosis. Typical well-
marginated, punched-out lytic defect in the
head of the third metacarpal (arrows).15

26. • Fig B 6-24 Hemophilia. (A) Large subchondral
cysts about the elbow. (B) Destructive,
expansile lesion of the lower tibial shaft.16

27. • Fig B 6-25 Hemangioendothelioma. Expansile
lucency containing delicate bony
trabeculation.

28. • Fig B 6-26 Cystic angiomatosis. Lytic lesion in the
proximal left humerus (arrow) with relatively
well-defined lobular margins and minimal
marginal sclerosis. Additional lytic lesions
(arrowheads) are in the midhumeral diaphysis.
Multiple lesions were seen elsewhere in the axial
and proximal appendicular skeleton.17

29. • Fig B 6-27 Sarcoidosis. Multiple osteolytic
lesions throughout the phalanges, having a
typical punched-out appearance. The
apparent air density in the soft tissues is a
photographic artifact.

30. • Fig B 6-28 PVNS. Large lucent lesion
(arrowheads) in the proximal tibia extending
to the articular surface, mimicking a giant cell
tumor.14