Solitary sclerotic bone lesion

Last revised by Dr Henry Knipe on 24 Nov 2022

Solitary sclerotic bone (osteosclerotic or osteoblastic) lesions are lesions of bone characterized by a higher density or attenuation on radiographs or computer tomography compared to the adjacent trabecular bone. However, a specific density range has not been specified for those terms 1.

The differential diagnosis of solitary sclerotic bone lesions can be narrowed down according to the following factors 1-3:

  • aggressive features

  • history of malignancy

  • ground glass appearance

  • cartilaginous matrix (rings and arcs appearance)

  • typically benign entities

Concerning the above factors the differential diagnosis includes the following lesions 1-3:

  • aggressive features →  might require an oncological referral and/or biopsy 1

  • history of malignancy →  will almost always require additional imaging, follow-up or oncologic referral

  • high CT attenuation values might help in the differentiation of bone island from osteoblastic metastases 5 but attenuation values should not be used exclusively for the assessment of sclerotic bone lesions 6

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Cases and figures

  • Case 1: bone island
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  • Case 2: prostate cancer metastasis
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  • Case 3: bone infarct of humerus
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