Differential Diagnosis for Ovoid Density on Iliac Crest on X-ray
- Single most likely diagnosis
- Bone island or enostosis: This is a common, benign lesion that appears as a well-defined, dense area within the bone, often found incidentally on radiographs. The iliac crest is a common location for bone islands.
- Other Likely diagnoses
- Osteoma: A benign bone tumor that can appear as a dense, ovoid lesion on the surface of the bone, including the iliac crest.
- Fibrous cortical defect (non-ossifying fibroma): Although more common in the metaphyses of long bones, these benign lesions can occasionally be found in the iliac crest and may appear as an ovoid density.
- Bone cyst: Such as a simple (unicameral) bone cyst, which can appear as a well-defined, ovoid lucency but may have a dense rim or internal density on X-ray.
- Do Not Miss diagnoses
- Metastasis: Although less likely, metastatic disease to the bone can present as an ovoid density and must be considered, especially in patients with a known history of cancer. Missing this diagnosis could have significant implications for patient management and prognosis.
- Multiple myeloma: A plasma cell malignancy that can cause well-defined, punched-out lesions or denser lesions in the bone, including the iliac crest. Early detection is crucial for treatment.
- Osteosarcoma: A primary bone malignancy that can present as an ovoid density with associated bone destruction or formation. It is rare but critical to diagnose early due to its aggressive nature.
- Rare diagnoses
- Osteoblastoma: A rare, benign bone tumor that can appear as a well-defined, dense lesion and is usually found in the spine or long bones but can occasionally occur in the iliac crest.
- Langerhans cell histiocytosis: A rare disorder that can cause bone lesions, which may appear as ovoid densities on X-ray, although these are more commonly found in the skull, mandible, or long bones.
- Chordoma: A rare, malignant bone tumor that typically occurs in the spine or base of the skull but can very rarely be found in other locations, including the iliac crest, presenting as an ovoid density.