CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 7 Moth-Eaten or Punched-Out
Osteolytic Destructive Lesions of
Bone

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

3. • Fig B 7-1 Multiple myeloma. Diffuse, punched-
out osteolytic lesions throughout the pelvis
and proximal femurs.

4. • Fig B 7-2 Heavy chain disease. Diffuse,
destructive bone lesions have led to a
pathologic fracture of the midshaft of the
femur.

5. Fig B 7-3 Ewing's sarcoma. Diffuse permeative destruction
involves virtually the entire radius.

6. • Fig B 7-4 Reticulum cell sarcoma. A moth-eaten
pattern of bone destruction in the proximal
humerus is associated with a pathologic fracture
(arrow).

7. • Fig B 7-5 Reticulum cell sarcoma. Diffuse
permeative destruction with mild periosteal
response involving the distal half of the femur.

8. • Fig B 7-6 Osteomyelitis. Patchy pattern of
bone destruction involves much of the shaft of
the radius. Note the early periosteal new bone
formation (arrows).

9. • Fig B 7-7 Chronic osteomyelitis. The involucrum (curved
arrows), a thick, irregular, bony sleeve, surrounds the
sequestrum (straight arrows), a residual segment of
avascular dead bone.

10. Fig B 7-8 Acute leukemia. Proliferation of neoplastic cells in the
marrow has caused extensive destruction of bone in both femurs.

11. • Fig B 7-9 Fibrosarcoma. Irregular destructive
lesion of the shaft of the radius.

12. Fig B 7-10 Osteogenic sarcoma. Primarily a lytic, destructive
process in the distal femur.

13. • Fig B 7-11 Diffuse lymphangiomatosis.
Multiple lytic lesions, some with thin sclerotic
rims, diffusely involve the pelvis.