Sandbox: foreverbones algorithm

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.

Plain

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Plain Radiograph

What type of bone is involved? ❑ Long bone ❑ Flat bone Where is the lesion located? ❑ Epiphysis ❑ Diaphysis ❑ Metaphysis ❑ Apophysis

Imaging Evaluation

What is the pattern involved? ❑ Osteoblastic ❑ Osteolytic ❑ Mixed What is the transversal location? ❑ Medullary ❑ Cortical ❑ Yuxtacortical What type of margin is involved? ❑ Well defined ❑ Ill-defined ❑ Sclerotic Is there a periosteal reaction? ❑ Yes ❑ No What is the size?

Malignant

Benign

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Imaging Evaluation

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Flat bone

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What type of bone is involved? ❑ Long bone ❑ Flat bone Where is the lesion located? ❑ Epiphysis ❑ Diaphysis ❑ Metaphysis ❑ Apophysis

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What is the pattern involved? ❑ Osteoblastic ❑ Osteolytic ❑ Mixed What is the transversal location? ❑ Medullary ❑ Cortical ❑ Yuxtacortical What type of margin is involved? ❑ Well defined ❑ Ill-defined ❑ Sclerotic Is there a periosteal reaction? ❑ Yes ❑ No What is the size?

Malignant

Benign

Initial patients evaluation

History and Symptoms ❑ Pain ❑ Response to analgesics Physical examination Age

Imaging

1) Conventional radiography ❑ What type of bone is involved? ❑ Location of the lesion ❑ Morphology of the lesion ❑ Type of calcified matrix involved ❑ Size 2) CT/MRI scan

Children and adolescents

Adults

See children and adolescent evaluation of bone and cartilage mass

Lesion characteristics

Well-defined Listed in frequency order

Ill-defined lesions Listed in frequency order

Sclerotic Listed in frequency order

❑ Metastases ❑ Myeloma ❑ Lymphoma ❑ Bone cyst ❑ Brown tumor

❑ Metastases ❑ Giant cell tumor ❑ Myeloma ❑ Chondrosarcoma

❑ Enchondroma ❑ Osteoma ❑ Fibrous dysplasia ❑ Bone islands ❑ Infection

ADULT

Initial patients evaluation

History and Symptoms ❑ Pain ❑ Response to analgesics Physical examination Age

Imaging

1) Conventional radiography ❑ What type of bone is involved? ❑ Location of the lesion ❑ Morphology of the lesion ❑ Type of calcified matrix involved ❑ Size 2) CT/MRI scan

More than 30 years Adults

Less than 30 years Children and adolescents

See adult evaluation of bone and cartilage mass

Lesion characteristics

Well-defined

Ill-defined lesions

Sclerotic

❑ Chondroblastoma ❑ Fibrous dysplasia ❑ Aneurysmal bone cyst ❑ Simple bone cyst ❑ Non ossifying fibroma ❑ Chondromyxoid fibroma ❑ Infection

❑ Ewing tumor ❑ Eosinophilic granuloma ❑ Osteosarcoma ❑ Infection

❑ Osteosarcoma ❑ Osteoid osteoma ❑ Fibrous dysplasia ❑ Eosinophilic granuloma ❑ Infection

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What type of bone is involved? ❑ Long bone ❑ Flat bone Where is the lesion located? ❑ Epiphysis ❑ Diaphysis ❑ Metaphysis ❑ Apophysis

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See differential diagnosis here

Benign

Malignant