Season 8 Case 30

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.

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