Abstract
Common causes of lytic bone lesions can be summarized by the acronym FEGNOMASHIC. In the spine, metastases preferentially destroy the pedicles due to high blood supply in this region, while multiple myeloma tends to spare the pedicles in early disease. The most common primary bone malignancy in adults is multiple myeloma. The most common infectious agent involved in osteomyelitis is Staphylococcus aureus. Osteomyelitis has characteristic appearances on imaging. It can take up to 10 days to show up on plain radiography, thus MRI and nuclear bone scans can provide earlier diagnosis. Common causes of osteolytic bone metastases include lung cancer, breast cancer, renal cell cancer, and thyroid cancer.
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Keywords
- FEGNOMASHIC
- Fibrous dysplasia
- Enchondromas
- Eosinophilic granuloma (langerhans cell histiocytosis)
- Giant cell tumor
- Nonossifying fibroma
- Osteoblastoma
- Metastatic disease
- Myeloma
- Anuerysmal bone cyst
- Solitary bone cyst
- Hyperparathyroidism
- Infection
- Chondroblastoma
- Osteomyelitis
- Staphylococcus aureus
- Lung cancer
- Breast cancer
- Renal cell cancer
- Thyroid cancer
What are some common causes of focal decrease on bone density (osteolysis)? | Osteolytic metastases, multiple myeloma, and osteomyelitis |
What are the entities making up the common acronym for lytic bone lesions, FEGNOMASHIC ? | Fibrous dysplasia, enchondromas and eosinophilic granuloma, giant cell tumor, nonossifying fibroma, osteoblastoma, metastatic disease and myeloma, aneurysmal bone cyst, solitary bone cyst, hyperparathyroidism, infection, and chondroblastoma |
How can one differentiate metastases from multiple myeloma in the spine? | Metastases in the spine preferentially destroy the pedicles due to high blood supply to this area, while metastases from multiple myeloma tend to spare the pedicle in early disease. |
What is the most common primary malignancy of bone in adults? | Multiple myeloma |
What is the most common infectious agent causing osteomyelitis ? | Staphylococcus aureus |
What are common radiologic characteristics of acute osteomyelitis? | (1) Focal cortical bone destruction, (2) periosteal new bone formation, (3) focal osteoporosis from hyperemia, and (4) preferential involvement of joint spaces in adults vs preferential involvement of metaphyses in children due to rich blood supplies |
How many days will it take for osteomyelitis to show up on conventional radiograph? | Osteomyelitis can take up to 10 days to show up on plain radiograph; MRI and nuclear bone scans can provide earlier diagnosis. |
What are common causes of osteolytic bone metastases ? | Lung cancer (most common lytic metastasis in males), breast cancer (most common lytic metastasis in females), renal cell cancer, and thyroid cancer |
Further Reading
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Guan, J. (2019). Focal Decrease in Bone Density. In: Eltorai, A., Hyman, C., Healey, T. (eds) Essential Radiology Review. Springer, Cham. https://doi.org/10.1007/978-3-030-26044-6_124
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