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Being able to recognize bone lesions, discern their aggressiveness, and formulate a competent differential diagnosis are skills that every good radiologist should have. Primary bone neoplasms are quite rare, and because of this it often rests on the radiologist’s shoulders to give an accurate differential diagnosis and guide the clinician’s next step and further management of the lesion. In this chapter, we are trying to provide basic steps and explanations of the musculoskeletal tumors to help in formulating diagnosis and follow-up. A team approach is important for diagnosis, proper treatment, and follow-up of these relatively rare entities. We first address benign and malignant bone tumors based on their matrix and then we will describe important multiple bone lesions, including metastasis and multiple myeloma (MM). At the end of the chapter, there is a brief discussion of soft tissue tumors.

Tips for Formulating a Differential Diagnosis

In evaluating bone lesions, it is essential to be able to synthesize a complete, yet succinct differential diagnosis. Thankfully, there are many other factors that aid in ruling certain entities in or out of a differential diagnosis besides imaging. Things such as the patient’s age (Tables 7-1 and 7-2), location of the lesion (Tables 7-3 and 7-4), and clinical history are invaluable information. That is why throughout this chapter, there will be emphasis placed on the age groups affected by each lesion, where the lesion commonly occurs, and any other characteristic information that would help narrow a differential diagnosis. At the conclusion of the chapter, there will be tables that break up bone tumors by age groups and list neoplasms with characteristic locations.

Table 7-1.Benign Bone Lesions to Consider Depending on Patient Age
Table 7-2.Malignant Bone Lesions to Consider Depending on Patient Age
Table 7-3.Benign Epiphyseal Lesions
Table 7-4.Bone Lesions with Characteristic Locations

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