Aneurysmal bone cysts

Aneurysmal bone cyst: well-defined cyst seen expanding the head of the fibula.
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Aneurysmal bone cysts

Characteristics

  • Can occur at any age. Commonest in 10–30 year olds with the majority arising prior to epiphyseal fusion.
  • Any bone may be affected but most commonly occur in long-bone metaphyses, especially the lower limb.
  • Aetiology unknown.

Clinical features

  • Pain associated with expansile lesions.
  • Pathological fractures may occur.
  • May be visible or palpable if sufficiently large.

Radiological features

  • Well-defined radiolucent cyst, often eccentric within bone. Marked ‘soap-bubble’ expansion may be seen.
  • Usually trabeculated with a thin intact cortex (narrow transition zone).
  • No periosteal reaction (except when fractured).
  • Within the spine, posterior elements are more commonly involved.
  • May be mistaken for other cyst-like lesions – see Bone cysts.
  • MRI/CT – fluid levels within cyst due to blood sedimentation (in up to 35%).
Aneurysmal bone cyst: well-defined cyst seen expanding the head of the fibula.

Aneurysmal bone cyst: well-defined cyst seen expanding the head of the fibula.

Aneurysmal bone cyst: coronal T1 and STIR MRI. The lesion is isointense on T1 and hyperintense on STIR with a narrow zone of transition.

Aneurysmal bone cyst: coronal T1 and STIR MRI. The lesion is isointense on T1 and hyperintense on STIR with a narrow zone of transition.

Management

  • Curettage and bone grafting, or substitute grafting.
  • If the ABC recurs, then consider bone cement rather than bone graft in the revision procedure.

Reference

James R. D. M., Erskine J. H., Rakesh R. M. (2008). Musculoskeletal Radiology. A-Z Musculoskeletal and Trauma Radiology, 1st edition, Cambridge University Press, Cambridge, 1, 1-176.

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