Bone Lesion on X-Ray - Differential Diagnosis Algorithm 

Exostotic

 • Osteochondroma

Asymptomatic &/or Non-Active Bone Scam

 • Unicameral Bone Cysts

 • Aneurysmal Bone Cysts

 • Non-ossifying Fibroma

Inflammatory Appearance

 • Osteoid Osteoma ("Nidus" appearance)

 • Osteoblastoma (may be malignant or sclerotic in appearance)

Not Inflammatory Appearance

 • Chondroblastoma

 • Chondromyxoid Fibroma

Multiple Lytic Lesions

 • Multiple Myeloma

Benign - No Bone Mineralization

 • Enchondroma (can calcify &/or turn malignant)

 • Giant Cell Tumor ("Soap Bubble" appearance)

Malignant - Bone Mineralization, Constitutional Symptoms, Codman's Triangle, Excessive Scalloping & Destruction of Cortical Bone

 • Osteosarcoma (Codman's Triangle)

 • Chondrosarcoma ("Popcorn" appearance)

 • Ewing's Sarcoma



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