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Challenge of the Unknowns—Unknown 1

Radiographic Findings and Differential Diagnosis



Click images to review films and listen to further audio discussion by Dr. Stephen Fridinger.


There is a single broad-based bony excrescence arises from the medial aspect of the right femoral neck, with trabecular pattern continuous with the parent bone. Adjacent to the superior portion of this lesion is a well-corticated lucency with a very narrow zone of transition. Also, the right femoral neck is wider than the left, representing likely abnormal remodeling. No associated soft tissue mass is noted. Note: If dedicated hip views were obtained, the characteristics of this lesion could be better identified.

There are a few questions that need to be addressed at this point. First, what does the bony lesion represent? Second, what does the adjacent lucency represent? Are these lesions related, and if so, which one caused the other? Third, what should we do next regarding imaging? Before we answer this last question, based on the radiograph, a confident diagnosis should be obtained. Of the following differential, the following differential may be considered:

1. Osteochondroma

2. Metastatic disease with associated periosteal reaction

3. Osteosarcoma

4. Osteoma



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Introduction to Unknown Cases

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