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