Bony Lesions on Chest X-Ray
March 4th, 2023
Overview
Potential bony lesions visible on chest x-ray include rib fractures, lytic (punched out) lesions and sclerotic (hyperopacified) lesions.
Rib Fractures
The chest x-ray often reveals old or new rib fractures, however x-rays have poor sensitivity for diagnosing rib fractures and these may often be missed. The diagnosis is usually made clinically or with further imaging as appropriate.
Interpretation
- Acute rib fractures - visible fracture line with no periosteal reaction or callus; may be displaced
- Old rib fractures - periosteal reaction, loss of fracture line definition or callus formation may be present; may be angulated
Causes of Rib Fracture
- Trauma - blunt, penetrating, CPR
- Pathologic fractures - solid organ malignancy, multiple myeloma
- Stress fractures - athletes, repeated coughing
Examples
- Multiple right-sided rib fractures which are likely acute
![Multiple right-sided rib fractures which are likely acute]()
- Old right-sided rib fractures
![Old right-sided rib fractures]()
- Old right-sided rib fractures
![Old right-sided rib fractures]()
Lytic Lesions
Look For
- Punched-out lesions within the bone.
Causes of Lytic Lesions
- Multiple myeloma
- Bony metastases
- Bone cysts
Bony Sclerotic Lesions
Look For
- Areas of sclerosis within bone.
Causes of Bony Sclerotic Lesions
- Infection - osteomyelitis
- Tumour - osteoma, sarcoma, bony metastasis
- Excessive fluoride intake
- Granuloma
- Haemangioma
- Bone island
Example
![Bony Sclerotic Lesions]()
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