Differential Diagnosis for Sclerotic Lesion in Iliac Spine

Single Most Likely Diagnosis

• Osteoblastic metastasis: This is a common cause of sclerotic lesions in the iliac spine, particularly in patients with a history of cancer such as prostate, breast, or lung cancer. The justification for this diagnosis is the high prevalence of metastatic disease to the bone and the iliac spine being a common site for such metastases.

Other Likely Diagnoses

• Bone island (enostosis): A benign condition characterized by a focal area of compact bone within the cancellous bone, often appearing as a sclerotic lesion on imaging. This diagnosis is justified due to the common occurrence of bone islands in the pelvis, including the iliac spine.
• Osteopoikilosis: A benign condition of bone characterized by multiple small, rounded or oval-shaped sclerotic lesions. The justification for including this diagnosis is its potential to present with sclerotic lesions in various bones, including the iliac spine.
• Sclerotic bone lesion due to Paget's disease: Although Paget's disease often presents with mixed lytic and sclerotic changes, it can sometimes appear as a purely sclerotic lesion, especially in its early stages. This diagnosis is considered due to the possibility of Paget's disease affecting the pelvis.

Do Not Miss Diagnoses

• Osteosarcoma: A primary malignant bone tumor that can present as a sclerotic lesion, particularly in younger patients. The justification for including osteosarcoma is its potential for aggressive behavior and poor prognosis if not promptly diagnosed and treated.
• Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can involve the bone and present as sclerotic lesions. This diagnosis is critical due to the need for early initiation of specific treatments for lymphoma.

Rare Diagnoses

• Melorheostosis: A rare bone disorder characterized by an excessive cortical bone formation, leading to sclerotic lesions. The justification for including melorheostosis is its unique appearance on imaging, which can sometimes mimic other sclerotic bone lesions.
• Sclerotic lesion due to Erdheim-Chester disease: A rare form of histiocytosis that can involve the bones and present with sclerotic lesions. This diagnosis is considered due to its rarity and the importance of recognizing it for appropriate management.