Enchondroma/Sclerotic Lesion

[ashtwin]

My knee xrays find a sclerotic lesion in the distal right femoral diaphysis possibly enchondroma.
I have constant deep down bone pain in my legs and hip. Where is this exaclty in reference to my knee anyway? I talked to my Doctor and he is only referring me for a MRI of the one knee, nothing more. He also said I had a bone spur. What?????????
First off a bone spur and sclerotic lesion aren't remotely close are they?
Secondly all that I have read about ths finding says it needs closer diangostics and possible biopsy.
What to do? What to do?

[jbadam01]

A related discussion, knee problems was started.

[Enoch Choi, MD]

yes, outside = further from the middle, the fibula

i have no additional information , just what's written.  i think you thought i had addl info since i pointed out it's at the bottom of the fibula, that's because ashtwin said it's distal

These are usually benign and just need to be followed to make sure they don't change

[vic_m]

Dr. Choi,

based on your response i'm assuming that you have information that is not in this thread (ie. patient IM'd you or something like that).

by the "outside" you must mean the fibula. perhaps this could be a good teaching case and you could elaborate on your line of thinking.

of course, when you have a moment. and thank you in advance.

[Enoch Choi, MD]

the cyst is at the bottom of the smaller lower leg bone, the outside one

the bone spur is probably in the knee, but you didn't say where

if in the knee, they're as far apart as you can get

[vic_m]

a bone spur and a sclerotic lesion are not the same thing. a bone spur (in the knee) is a fairly common x-ray finding in older patients.

sclerotic changes are not very common and can be caused by a few different mechanisms. the exact reason for why a person has a sclerotic lesion should be investigated thoroughly.

the diaphysis refers to the shaft of any long bone. the ends are called the epiphysis. so, based on your description, the lesion is located and the end of the shaft of the femur, which is your thigh bone. so that's near the end of your thigh, above your knee.

while an mri is pretty useless in assessing the structure of normal bone, it is useful in this case because it shows a lot of imformation about the lesion, and the surrounding tissue. i wouldn't imagine that the other knee should be mri'd as well because you are not having any problems. biopsy is a possibliity in the future, based on mri results. however, it's not the initial diagnostic test. bone biopsies are complicated procedures and require a great deal of expertise. you usually don't have one done unless you really need one. it's also fairly painful and carries a risk of complications.