Differentials for this appearance?
This lesion has aggressive features. Differentials include osteomyelitis, Ewing's sarcoma, osteosarcoma and histiocytosis.
Next management steps:
Correlation with infectious symptoms, MRI of the limb including the joint above and below, discussion at bone tumour/sarcoma MDT +/- onward referral for biopsy.
There is a lucent lesion located centrally within the proximal tibial diaphysis. It demonstrates a relatively narrow but indistinct zone of transition. Periosteal reaction is seen involving the medial aspect of the tibia.