Management of Asymptomatic Bone Islands in the Hip

Initial Diagnostic Confirmation

• The American College of Radiology explicitly states that asymptomatic benign-appearing lesions on radiographs are typically incidental findings requiring no further imaging evaluation 1, 4, 5

No Additional Imaging Needed

• CT imaging is not routinely used for lesions that are definitely benign on radiographs 1, 2, 5
• MRI is not routinely used for lesions that are definitely benign on radiographs 1, 2, 6
• Bone scan is not routinely used for definitively benign lesions 1, 6
• FDG-PET/CT is not routinely used for definitively benign lesions 1, 2
• Biopsy is not routinely performed for definitively benign lesions 6

When to Consider Further Evaluation

• If symptoms develop, MRI without and with IV contrast may identify unusual complications such as stress fracture, secondary aneurysmal bone cyst formation, or malignant transformation 5, 6, 7
• CT without IV contrast may be useful if symptomatic to identify complications or for surgical planning 1, 2, 5

Clinical Management Algorithm

• Verify patient is asymptomatic: No pain, no functional limitation 5
• Document in medical record: Prevents unnecessary future workup 1