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Chest X-Ray
 
 

Bony Lesions on Chest X-Ray

March 4th, 2023
 
 
 
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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
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    Multiple right-sided rib fractures which are likely acute
     
  • Old right-sided rib fractures
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    Old right-sided rib fractures
     
  • Old right-sided rib fractures
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    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

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    Bony Sclerotic Lesions
     
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