Differential Diagnosis for Focal Lucency in Rib Cage

• Single most likely diagnosis
  • Rib fracture: The presence of focal lucency in the ribs, especially when correlated with a history of trauma or focal point of tenderness, makes fracture a highly plausible diagnosis. The size of the lucency (7 mm) and its location in the left third rib, along with another questionable lucency in the right 10th rib, supports this diagnosis.
• Other Likely diagnoses
  • Bone cyst or benign bone tumor: These could present as focal lucencies in the ribs. However, they are less likely than a fracture given the context of potential trauma.
  • Metastatic disease: Although less common, metastatic lesions to the ribs can appear as lucencies. A history of known primary malignancy would increase the likelihood of this diagnosis.
  • Infection (osteomyelitis): Infection of the bone could also present with lucency, but this would typically be accompanied by other clinical signs such as fever, redness, and swelling.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Multiple myeloma: A malignant condition that can cause lytic lesions in bones, including the ribs. Early detection is crucial for treatment.
  • Aggressive bone tumors (primary or metastatic): While less likely, missing an aggressive tumor could have significant implications for patient outcomes.
• Rare diagnoses
  • Langerhans cell histiocytosis: A rare condition that can cause lytic bone lesions, including in the ribs.
  • Fibrous dysplasia: A condition where normal bone is replaced with fibrous tissue, leading to weakened bones and potential for lesions that could appear as lucencies on imaging.
  • Brown tumor of hyperparathyroidism: A rare condition associated with hyperparathyroidism that can cause bone lesions, including in the ribs.