Season 8 Case 30

Season 8 Mar 26, 2020

History: foot pain













Answer: Intraosseous lipoma of the calcaneous

but I bet everyone knew that!

Classic appearance = a well circumscribed lytic lesion in the calcaneal body with central Ca++ (aka cockade sign)

Whats a cockade?

= a rosette - a knot of ribbon rolled into a badge.

image



So central density surrounded by well circumscribed low density area


Differential diagnosis (for calcaneous):

1) normal triangular lucency in this same area due to the normal stress related trabecular struts (more 🔺 in appearance)

2) Unicameral bone cyst - often very similar looking BUT NO central Calcification


  Intraosseous Lipoma:

- most common lipogenic bone tumor
- majority in lower limbs
- ~1/3 in calcaneous**
- most common calcaneal bone lesion**
-CT/MR can confirm internal fat

-often incidental on XR but can present with heal pain

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Professor of the Darkroom Arts

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