Differential Diagnosis for Lucent Vertebral Lesions
Single Most Likely Diagnosis
- Osteoporotic compression fracture: This is often the most common cause of lucent vertebral lesions, especially in elderly patients or those with a history of osteoporosis. The fracture leads to a decrease in bone density, making the vertebra appear lucent on imaging.
Other Likely Diagnoses
- Metastatic disease: Metastases to the spine from various cancers (e.g., breast, lung, prostate) can cause lytic (lucent) lesions in the vertebrae. The presence of a known primary malignancy increases the likelihood of this diagnosis.
- Multiple myeloma: This plasma cell dyscrasia can lead to multiple lucent lesions throughout the spine due to the replacement of normal bone marrow with malignant plasma cells.
- Hemangioma: Vertebral hemangiomas are benign vascular tumors that can cause well-defined lucent lesions, often with a characteristic "honeycomb" or "corduroy" appearance on imaging.
Do Not Miss Diagnoses
- Infection (osteomyelitis or discitis): Although less common, spinal infections can present with lucent lesions and are critical to diagnose promptly due to the potential for serious complications, including abscess formation and neurological deficits.
- Eosinophilic granuloma (Langerhans cell histiocytosis): This rare condition can cause lytic lesions in the spine, among other sites, and is important to recognize due to its potential impact on the patient's health and the need for specific treatment.
Rare Diagnoses
- Giant cell tumor: These tumors are rare in the spine but can cause expansile, lytic lesions, typically in the sacrum or vertebral bodies.
- Aneurysmal bone cyst: This is a rare, benign lesion that can occur in the spine, presenting as a lucent, expansile lesion, often with fluid-fluid levels on MRI.
- Plasmacytoma: A solitary lesion of multiple myeloma, plasmacytoma can present as a lucent lesion in the vertebrae and is considered in the differential diagnosis, especially in patients with a known history of myeloma or those at risk.