Differential Diagnosis for a Lytic 5th Rib Lesion
Single Most Likely Diagnosis
- Metastatic disease: The most common malignant bone tumors are metastases, and the rib is a common site for metastatic disease, particularly from breast, lung, and prostate cancer. A lytic lesion in the 5th rib is more likely to be a metastasis than a primary bone tumor.
Other Likely Diagnoses
- Multiple myeloma: This is a plasma cell malignancy that can cause lytic bone lesions, and the rib is a possible site of involvement. Multiple myeloma is more common in older adults and can cause widespread bone destruction.
- Chordoma: Although rare, chordomas are malignant bone tumors that can arise in the ribs, including the 5th rib. They are more common in men and typically occur in the axial skeleton.
- Ewing's sarcoma: This is a rare, malignant bone tumor that can occur in the ribs, including the 5th rib. Ewing's sarcoma is more common in children and young adults.
Do Not Miss Diagnoses
- Osteosarcoma: Although rare, osteosarcoma is a highly aggressive malignant bone tumor that can arise in the ribs, including the 5th rib. It is more common in children and young adults, but can occur at any age.
- Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can involve the bone, including the ribs, and cause lytic lesions. Lymphoma is more common in older adults and can cause systemic symptoms.
Rare Diagnoses
- Giant cell tumor: This is a rare, benign but locally aggressive bone tumor that can cause lytic lesions in the ribs, including the 5th rib. Giant cell tumors are more common in adults after skeletal maturity.
- Chondrosarcoma: This is a rare, malignant bone tumor that can arise in the ribs, including the 5th rib. Chondrosarcomas are more common in older adults and can cause lytic lesions.
- Plasmacytoma: This is a rare, solitary plasma cell malignancy that can cause a lytic lesion in the 5th rib. Plasmacytoma is more common in older adults and can be a precursor to multiple myeloma.