Orthonotes
Orthonotes
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Approach to Lytic Bone Lesions

A lytic bone lesion on X-ray should be approached systematically using five steps: patient age (the single most powerful clue — under 20 favours benign lesions, over 40 mandates excluding metastasis and myeloma first), location within the bone (epiphysis, metaphysis, or diaphysis each suggest specific diagnoses), zone of transition (narrow/sclerotic rim = benign; permeative = highly aggressive), periosteal reaction (solid = benign; Codman's triangle/sunburst/onion-skin = malignant), and matrix p...