Bone Lesions Case 3 Diagnosis
It is important to order plain films for patients with bone pain and a history of or concern for malignancy.
The radiographic appearance of lytic lesions are characteristically 'punched-out' areas - circular or ovoid radiolucent areas without surrounding sclerosis. 90% of the time there are multiple lesions. Lytic lesions weaken bone and predispose to pathologic fracture, which should be suspected if pain is acute, post-traumatic, or suddenly worse. The differential diagnosis includes primary bone tumors, sarcoma (especially in area of previous radiation), Paget's disease, and chronic osteomyelitis (especially tuberculous).