Sclerotic Bone Lesion

Sclerotic bone lesions replace the normal bone with lesions that are whiter or denser on x-rays.  Sclerotic bone lesions can represent numerous diagnosis.  We can narrow the diagnostic possibilities based on the age of the patient, clinical information and appearance on X-rays.

What are sclerotic bone lesions

Sclerotic bone lesions replace the normal bone with lesions which are whiter and denser on X-rays.  Sclerotic lesions of bone can occur in children and adults.  There can be one sclerotic lesion or many.

What are causes of sclerotic bone lesions

There are many causes of sclerotic lesions of bone.  We can narrow the possibilities by looking at the age of the patient, their history and whether they have cancer.

Pain attributable to a lesion is a concerning feature.

It helps to know if there is one or multiple sclerotic lesions.

We can assess how aggressive the lesion looks like on an X-ray.   Ill defined margins, aggressive periosteal reaction, involvement of the cortex, extension outside the bone, or a fracture associated with the lesion helps us to determine a lesion is aggressive.

Aggressive features makes a lesion concerning for tumors like myeloma, chondrosarcoma, metastasis and infection.   Some lesions are clearly benign and others are indeterminate and will need follow up.

Benign sclerotic lesions include bone islands, bone infarcts, paget’s disease, non ossifying fibroma, and hemangioma to name some.

Are sclerotic bone lesions cancerous

Sclerotic lesions can represent a spectrum of lesions ranging from completely benign to aggressive and cancerous.  The imaging appearance will allow us to make a better determination.  Further imaging and biopsy will be needed in some cases.

How are sclerotic bone lesions diagnosed?

Sclerotic bone lesions are best assessed on X-rays.  We can use the imaging appearance of the lesion combined with the clinical information to arrive at a diagnosis or set of possibilities.  Bone scans, CT and MRI allow us to get more information about the lesions.

How are sclerotic bone lesions treated?

Sclerotic bone lesions are treated based on the specific cause.  Those which are benign are left alone.  Infections, metastasis and primary tumors are all treated in different ways.

Are sclerotic lesions serious?

They can be in some cases.  Some sclerotic lesions can represent a primary cancer or spread of cancer from somewhere else in the body.  Sclerotic lesions can also represent infection of the bone.

Sclerotic bone lesions summary

Sclerotic bone lesions are whiter and denser than the normal bone on X-rays.  Sclerotic bone lesions can represent a variety of diagnosis.  The age of the patient, clinical information and appearance on imaging helps us narrow the possibilities.  Aggressive lesions on imaging may require oncology referral and biopsy for diagnosis.


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