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Bony sequestrum: a radiologic review

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According to a pathological definition, a bony sequestrum is defined as a piece of devitalized bone that has been separated from the surrounding bone during the process of necrosis. However, the radiological definition of a sequestrum is different and refers to an image of calcification visible within a lucent lesion, completely separated from the surrounding bone, without referring to the vascular status and histological nature of the calcified tissue. The term “button sequestrum” has been used in calvarial lesions. The prototype conditions that may present with a bony sequestrum are osteomyelitis and skeletal tuberculosis. Other conditions such as radiation necrosis, eosinophilic granuloma, metastatic carcinoma, primary lymphoma of bone, aggressive fibrous tumors may also manifest as osteolytic lesions containing a sequestrum. In addition, some primary bone tumors produce a matrix that may mineralize and sometimes simulate a bone sequestrum. These include osteoid tumors (osteoid osteoma, osteoblastoma), cartilaginous tumors (chondroma and chondroblastoma), lipomatous tumors (lipoma), and benign fibrous tumors (fibromyxoma, myxoma, and desmoplastic fibroma). Therefore, various conditions may present at imaging as a small area of osteolysis containing central calcifications. However, a careful analysis of the sequestrum as well as the associated clinical and radiological findings often enables to point toward a limited number of conditions.

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  1. Dorland WAN. Dorland's illustrated medical dictionary. W B Saunders, Philadelphia; 2000.

    Google Scholar 

  2. Wells PO. The button sequestrum of eosinophilic granuloma of the skull. Radiology 1956;67:746–7.

    PubMed  CAS  Google Scholar 

  3. Tirona JP. The roentgenological and pathologic aspects of tuberculosis of the skull. Am J Roentgenol. 1954;72:762–8.

    CAS  Google Scholar 

  4. Rosen IW, Nadel HI. Button sequestrum of the skull. Radiology 1969;92:969–71.

    PubMed  CAS  Google Scholar 

  5. Azouz EM, Saigal G, Rodriguez MM, Podda A. Langerhans' cell histiocytosis: pathology, imaging and treatment of skeletal involvement. Pediatr Radiol. 2005;35:103–15.

    Article  PubMed  Google Scholar 

  6. Kroon HM, Schurmans J. Osteoblastoma: clinical and radiologic findings in 98 new cases. Radiology 1990;175:783–90.

    PubMed  CAS  Google Scholar 

  7. Shanley DJ. Tuberculosis of the spine: imaging features. AJR Am J Roentgenol. 1995;164:659–64.

    PubMed  CAS  Google Scholar 

  8. Resnick D. Osteomyelitis, septic arthritis, and soft-tissue infection. In: Diagnosis of bone and joint disorders, 4th edn. Philadelphia: Saunders; 2002. p. 2372–2550.

  9. De Backer AI, Mortele KJ, Vanhoenacker FM, Parizel PM. Imaging of extraspinal musculoskeletal tuberculosis. Eur J Radiol. 2006;57:119–30.

    Article  PubMed  Google Scholar 

  10. Ousehal A, Adil A, Abdelouafi A, Kadiri R. Centrosomatic spinal tuberculosis: radiographic features in 10 cases. J Neuroradiol. 2000;27:247–52.

    PubMed  CAS  Google Scholar 

  11. Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics 2007;27:1255–73.

    Article  PubMed  Google Scholar 

  12. Sellier P, Wyler A. Disseminated tubercular osteitis. Can Med Assoc J. 2007;177:48.

    Article  Google Scholar 

  13. Camp JD, Moreton RD. Radiation necrosis of the calvarium. Report of five cases. Radiology 1945;45:213–9.

    Google Scholar 

  14. Kilpatrick SE, Wenger DE, Gilchrist GS, Shives TC, Wollan PC, Unni KK. Langerhans' cell histiocytosis (histiocytosis X) of bone. A clinicopathologic analysis of 263 pediatric and adult cases. Cancer 1995;76:2471–84.

    Article  PubMed  CAS  Google Scholar 

  15. Mitnick JS, Pinto RS. Computed tomography in the diagnosis of eosinophilic granuloma. J Comput Assist Tomogr. 1980;4:791–3.

    Article  PubMed  CAS  Google Scholar 

  16. Hindman BW, Thomas RD, Young LW, Yu L. Langerhans cell histiocytosis: unusual skeletal manifestations observed in thirty-four cases. Skeletal Radiol. 1998;27:177–81.

    Article  PubMed  CAS  Google Scholar 

  17. Mayo-Smith W, Rosenthal DI, Kattapuram SV, Rosenberg AE. Case report 542. Eosinophilic granuloma of femur. Skeletal Radiol. 1989;18:245–7.

    Article  PubMed  CAS  Google Scholar 

  18. Tordeur M, Wybier M, Laporte JL, Grenier P, Laredo JD. Button sequestrum in a case of localized Langerhans' cell histiocytosis of the ilium: case report. Can Assoc Radiol J. 2000;51:90–2.

    PubMed  CAS  Google Scholar 

  19. Sartoris DJ, Resnick D, Guerra J Jr. Vertebral venous channels: CT appearance and differential considerations. Radiology 1985;155:745–9.

    PubMed  CAS  Google Scholar 

  20. Resnick D, Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In: Diagnosis of bone and joint disorders, 4th edn. Philadelphia: Saunders, 2002; 3763–4128 and 4278.

  21. Mulligan ME, McRae GA, Murphey MD. Imaging features of primary lymphoma of bone. AJR Am J Roentgenol. 1999;173:1691–7.

    PubMed  CAS  Google Scholar 

  22. Krishnan A, Shirkhoda A, Tehranzadeh J, Armin AR, Irwin R, Les K. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics 2003;23:1371–83, discussion 1384–1377.

    Article  PubMed  Google Scholar 

  23. Mulligan ME, Kransdorf MJ. Sequestra in primary lymphoma of bone: prevalence and radiologic features. AJR Am J Roentgenol. 1993;160:1245–8.

    PubMed  CAS  Google Scholar 

  24. Helms CA, Jeffrey RB, Wing VW. Computed tomography and plain film appearance of a bony sequestration: significance and differential diagnosis. Skeletal Radiol. 1987;16:117–20.

    Article  PubMed  CAS  Google Scholar 

  25. Yamaguchi T, Dorfman HD. Radiographic and histologic patterns of calcification in chondromyxoid fibroma. Skeletal Radiol. 1998;27:559–64.

    Article  PubMed  CAS  Google Scholar 

  26. Weatherall PT, Maale GE, Mendelsohn DB, Sherry CS, Erdman WE, Pascoe HR. Chondroblastoma: classic and confusing appearance at MR imaging. Radiology 1994;190:467–74.

    PubMed  CAS  Google Scholar 

  27. Campbell RSD, Grainger AJ, Mangham DC, Beggs I, Teh J, Davies A. Intraosseous lipoma: report of 35 new cases and a review of the literature. Skeletal Radiol. 2003;32:209–22.

    Article  PubMed  CAS  Google Scholar 

  28. Milgram JW. Intraosseous lipomas with reactive ossification in the proximal femur. Report of eight cases. Skeletal Radiol. 1981;7:1–3.

    Article  PubMed  CAS  Google Scholar 

  29. Kuhne CA, Engelhorn T, Homann M, Taeger G, Nast-Kolb D. Fibromyxoma of the iliac wing. Skeletal Radiol. 2003;32:170–3.

    Article  PubMed  CAS  Google Scholar 

  30. Abdelwahab IF, Hermann G, Klein MJ, Kenan S, Lewis MM. Fibromyxoma of bone. Skeletal Radiol. 1991;20:95–8.

    PubMed  CAS  Google Scholar 

  31. Vanhoenacker FM, Hauben E, De Beuckeleer LH, Willemen D, Van Marck E, De Schepper AM. Desmoplastic fibroma of bone: MRI features. Skeletal Radiol. 2000;29:171–5.

    Article  PubMed  CAS  Google Scholar 

  32. Bohm P, Krober S, Greschniok A, Laniado M, Kaiserling E. Desmoplastic fibroma of the bone. A report of two patients, review of the literature, and therapeutic implications. Cancer 1996;78:1011–23.

    Article  PubMed  CAS  Google Scholar 

  33. Liu PT, Chivers FS, Roberts CC, Schultz CJ, Beauchamp CP. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology 2003;227:691–700.

    Article  PubMed  Google Scholar 

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Correspondence to Félicie Jennin.

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Jennin, F., Bousson, V., Parlier, C. et al. Bony sequestrum: a radiologic review. Skeletal Radiol 40, 963–975 (2011).

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