History and Physical Examination

Patients with an aneurysmal bone cyst (ABC) usually present with pain, a mass, swelling, a pathologic fracture, or a combination of these symptoms in the affected area. The symptoms are usually present for several weeks to months before the diagnosis is made, and the patient may also have a history of a rapidly enlarging mass. Neurologic symptoms associated with ABCs may develop secondary to pressure or tenting of the nerve over the lesion, typically in the spine.

Pathologic fracture occurs in about 8% of ABCs, but the incidence may be as high as 21% in ABCs that have spinal involvement.

Other findings may include the following:

Deformity
Decreased range of motion, weakness, or stiffness
Reactive torticollis
Occasionally, bruit over the affected area
Warmth over the affected area

Differential Diagnoses

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Media Gallery

Aneurysmal bone cyst of the upper arm. Courtesy of Johannes Stahl, The Virtual Radiological Case Collection.
Aneurysmal bone cyst of the upper arm. Courtesy of Johannes Stahl, The Virtual Radiological Case Collection.
Aneurysmal bone cyst affecting the lumbar spine. Courtesy of Nick Oldnall, Index: Spine.
Aneurysmal bone cyst of the upper arm in a 13-year-old female adolescent. Left to right, the radiographs were obtained over a period of approximately 2 months. Courtesy of Armed Forces Institute of Pathology.
Aneurysmal bone cyst of the upper arm in an 18-year-old woman. Note the cortical erosion and slight expansion. Courtesy of Armed Forces Institute of Pathology.
Aneurysmal bone cyst of the upper arm. Used with permission from the American Registry of Pathology. Courtesy of Armed Forces Institute of Pathology.
Aneurysmal bone cyst of the upper arm. Used with permission from the American Registry of Pathology. Courtesy of Armed Forces Institute of Pathology.
In this histologic image, the vascular spaces vary widely in size and shape, and the septa range from thin to broad. Well-formed bone is focally present. Courtesy of Armed Forces Institute of Pathology.
In this histologic image, the septum contains fibroblasts, mononuclear histiocytelike cells, multinucleated giant cells, and capillaries. The lining of the large vascular spaces may be indistinct or consist of a single layer of attenuated stromal cells, as seen here. Used with permission from the American Registry of Pathology. Courtesy of Armed Forces Institute of Pathology.
This histologic image demonstrates lesional tissue that abuts the striated tissue where the cortex has been completely destroyed. Used with permission from the American Registry of Pathology. Courtesy of Armed Forces Institute of Pathology.
This histologic image shows a fibrous septum that contains a long strand of osteoid that appears to have buckled in the center. Used with permission from the American Registry of Pathology. Courtesy of Armed Forces Institute of Pathology.
Aneurysmal bone cyst of distal radius in 11-year-old male. Note multiple septations, lytic cyst cavity, and extensive cortical thinning and expansion wider than adjacent distal radius physis in both anteroposterior and lateral planes.
Axial and sagittal T2-weighted MRI of distal femoral aneurysmal bone cyst. Note multiple fluid-fluid levels throughout lesion consistent with multiple blood-filled cavities separated by small septa.

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Author

Nicholas Tedesco, DO, FAAOS Orthopedic Oncology and Joint Reconstruction, Good Samaritan Residency Associate Director, Samaritan Medical Group

Nicholas Tedesco, DO, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Osteopathic Academy of Orthopedics, American Osteopathic Association, Musculoskeletal Tumor Society

Disclosure: Private stock ownership for: ROMTech LLC.

Coauthor(s)

Bart Eastwood, DO Orthopedic Surgeon and Sports Medicine Specialist, OrthoVirginia

Bart Eastwood, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Orthopedics, American Osteopathic Association, Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Omohodion (Odion) Binitie, MD Medical Director, Assistant Member, Department of Sarcoma, Section Head, Orthopedics, Adolescent/Young Adult and Pediatric Orthopedic Oncology, Medical Director, Physical Therapy, Speech Therapy, and Rehabilitation Services, Assistant Fellowship Program Director, Musculoskeletal Oncology, Moffitt Cancer Center; Assistant Professor, Department of Oncologic Sciences, Department of Ortho and Sports Medicine, University of South Florida Morsani College of Medicine

Omohodion (Odion) Binitie, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Children's Oncology Group, Florida Orthopaedic Society, Musculoskeletal Tumor Society

Disclosure: Nothing to disclose.

Additional Contributors

Howard A Chansky, MD Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center

Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

H Kurtis Biggs, DO Consulting Staff, Department of Orthopedics, Doctors Hospital of Stark County

Disclosure: Nothing to disclose.

Mark McFarland, DO Staff Physician, Department of Orthopedics, Doctors Hospital of Stark County

Disclosure: Nothing to disclose.