A radiological diagnostic approach to tumours and tumour-like lesions of the calcaneus

Abstract

Objective: The calcaneus is a rare location for the development of primary bone tumours. The purpose of the study is to review the imaging findings in a cohort of patients presenting with tumours and tumour-like lesions of the calcaneus and to develop a more structured approach to the diagnosis of calcaneal lesions. Methods: A retrospective study with a collection of 167 cases of calcaneal tumours and tumour like lesions from our tertiary orthopedic oncology institution over a period of 13 years. Cases were reviewed by two consultant musculoskeletal radiologist and the location of the lesion within the calcaneus and demographics of the patient were noted for each case. A diagnostic algorithm which is based on patient age and tumour location was then extrapolated. Results: Out of the 167 cases we identified 24 different calcaneal pathologies which included both tumours and tumour-like lesions. The most common being simple bone cysts (18.3% of cases) and intra osseous lipoma (15% of cases) sited in the diaphyseal equivalent of the calcaneus. A diagnostic algorithm was formulated which describes the most common location of the different pathologies including both benign and malignant pathologies, subdivided by age. Conclusion: Our algorithm should help the radiologist narrow down the differential diagnosis when evaluating calcaneal lesions. Advances in knowledge: This article provides a radiological approach to calcaneal lesions.

Benign incidental lesion of the calcaneus: the calcaneal vascular remnant

“…Although the lesions were predominantly small, some lesions could reach approximately 19 mm in size. This finding might support the theory that these lesions can continue to grow through the vascular channel and anastomosis (16)(17)(18)(19)(20)(21). None of the lesions in our study had imaging features that could be described as aggressive in nature suggestive of a malignancy, bone marrow edema, or traumatic components.…”

“…Although located close to the calcaneal sulcus, like benign calcaneal bone cysts, the calcaneal vascular remnant is a completely different lesion. In fact, although the two are different lesions, the current literature tries to explain the formation mechanism of calcaneal bone cysts with the theory of vascular nutrition, such as calcaneal vascular remnant (16)(17)(18)(19)(20)(21). The calcaneal lipoma, another benign calcaneal lesion, mostly develops based on these cysts (19,20).…”