- Bone infarct
- Infection
- Paget's disease
- Osteoid osteoma
- Osteoblastoma
- Enchondroma
- Chondromyxoid fibroma
- Non-ossifying fibroma (fibrous cortical defect, fibrous histiocytoma of bone)
- Fibrous dysplasia
- Osteofibrous dysplasia (in tibia)
- Unicameral bone cyst
- Histiocytosis X
- Osteosarcoma
- Chondrosarcoma
- Non-osteogenic spindle cell sarcoma of bone (MFH of bone, fibrosarcoma of bone)
- Myeloma
- Lymphoma
- Adamantinoma (tibia and, rarely, ulna)
- Metastatic disease
This is a long list, but it can be shortened and focused on the basis of radiographic analysis.
- Osteoid osteoma, infection, enchondroma, bone infarct and Paget's disease have typical Xray findings.
- Osteofibrous dysplasia and adamantinoma are typically tibial lesions.
- Non-ossifying fibroma, fibrous cortical defects, and chondromyxoid fibroma are eccentric geographic lesions.
- Fibrous dysplasia is suspected by multiple bone involvement, deformities, and ground glass appearance.
- Osteosarcoma and chondrosarcoma have typical patterns of matrix formation.
- Non-osteogenic spindle cell sarcoma of bone (ie, MFH, fibrosarcoma, leiomyosarcoma of bone) and lymphoma classically demonstrate permeative bony lysis.
- Metastatic disease is suggested by the patient's age and the presence of multiple lesions.
- Myeloma is generally a highly lytic lesion, often demonstrating diffuse osteopenia.
