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Benign Cortical Defect
Fibrous Cortical Defect, Non-ossifying fibroma

General Considerations

  • Also called a non-ossifying fibroma or fibrous cortical defect
    • Non-ossifying fibroma frequently reserved for lesions > 2cm in size in older children
  • Usually arises in metaphysis of distal femur or tibia
  • Solitary lesion (75%) or multiple (25%)
  • Most commonly seen in children 2-15 years of age
  • May be secondary to a prior trauma injury (traction) as they tend to occur at sites of insertion of tendons and ligaments

Clinical Findings

  • Usually asymptomatic
  • Found serendipitously

Imaging Findings

  • Geographic lytic lesion
  • Septated
  • Metaphyseal
  • Eccentric
  • Well-marginated
  • Sclerotic rim
  • Endosteal scalloping
  • On healing
    • Marginal sclerosis increases
    • Lesions “fill-in” from diaphyseal side of bone
  • Bone scan
    • May show increased activity on healing of the lesion
  • MRI
    • Variable signal intensity depending on healing stage
    • Central decreased T2-W signal
      • From collagen and hemosiderin deposits

Differential Diagnosis

  • Image on conventional radiography is usually diagnostic

Treatment

  • None required

Complications

  • Rarely may undergo pathologic fracture
  • Do not undergo malignant transformation

Prognosis

  • Migrate away from epiphysis towards diaphysis with age
  • Most lesions heal spontaneously by being replaced with normal bone


Benign Cortical Defect.
White arrow (top) points to a well-circumscribed, lytic lesion in the metaphysis of this child's distal femur. It has a sclerotic rim. On the lateral view, its cortical nature is again demonstrated (yellow arrow).
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