Bone Surface Lesion
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
- • Radiographs or other imaging very helpful when assessing bone surface lesions on US
- • US cannot assess intramedullary extent or surrounding bone quality
- • Beware of normal bone irregularity at sites of muscle insertion and previous surgery
- • Heavy calcification or ossification alongside bone may appear attached to bone on US
- • Only portion of bony lesion visible with US
- • Determining etiology of surface bone lesions is often helped by clinical features
- • US-guided biopsy of bone tumor is possible if extraosseous mass is present
- • US-guided biopsy of intramedullary component of bone tumor or infection is possible via cortical breach if present
Helpful Clues for Common Diagnoses
- • Osteochondroma
Most common bone surface tumor
Metaphyseal or metadiaphyseal in location
Majority are solitary
Variable thickness in hypoechoic cartilage cap
Most osteochondromas are asymptomatic
Symptoms can be due to several causes
Reactive myositis secondary to friction between osteochondroma and adjacent muscle
Reactive bursitis
Pseudoaneurysm
Bleeding
Neurological sequelae
Fracture
Malignant transformation more common with
- • Other Benign Bone Tumor
- • Malignant Bone Tumor
Helpful Clues for Less Common Diagnoses
- • Metastases
- • Bone T umor Recurrence
US is very useful at screening for bone tumor recurrence
Based on premise that most bone tumor recurrences occur in juxtacortical soft tissues rather than in bone
Unlike MR, US assessment of juxtacortical soft tissues is not affected by metallic prosthesis
Tumor recurrence usually mirrors imaging characteristics of original tumor
If recurrence is detected, check regional lymph nodes, as nodal involvement is more frequent with recurrence than with primary bone tumor
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