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往期相关链接： 【双语病例】骨性纤维结构不良-OFD
【双语病例】(股骨远端)软骨母细胞瘤
【双语病例】（桡骨远段）尤文肉瘤（Ewing's sarcoma） 【双语病例】骨肉瘤（X线/MRI） 【双语病例】（髋臼）骨样骨瘤 [X线、CT]
History: A 46-year-old man has an incidental finding of a calcaneal mass on CT. 病史：46岁男性，CT检查偶然发现跟骨肿物。 Unenhanced CT images are shown below. In order: sagittal plane in bone window and soft-tissue window. CT平扫图像如下所示，按顺序：矢状位骨窗及软组织窗。 
Findings: CT demonstrates a well-circumscribed predominantly fatty mass with internal coarse linear calcification.Cockade sign is seen. 影像表现： CT上表现为一边界清楚的脂肪密度为主的肿物，内部可见粗糙的线样钙化，表现为“帽徽征”。 Differential diagnosis Intraosseous lipoma Simple cyst Aneurysmal bone cyst Unicameral bone cyst Bone infarct
鉴别诊断： 骨内脂肪瘤 单纯囊肿 动脉瘤样骨囊肿 单房性骨囊肿 骨梗死
Diagnosis: Calcaneal intraosseous lipoma
诊断：跟骨骨内脂肪瘤
Key pointsIntraosseous lipomas 骨内脂肪瘤 Pathophysiology Intraosseous lipomas are benign tumors of the bone. Their precise etiology is unknown.Many believe they represent a benign primary neoplasm of bone.Others believe they are due to a degenerative phenomena following trauma, infection, or bone infarct. Histologically, they are characterized by mature lipocytes in a background of fibroblasts with occasional fat necrosis. They may be strictly intraosseous and medullary or parosteal.
病理生理学
Epidemiology Their true incidence is largely unknown. Some researchers believe they represent less than 0.1% of primary bone tumors. There is an equal male and female distribution. Mean age range of patients is 40 to 43. The lower limbs are most often involved. The calcaneus is the most common site within the lower limb.
流行病学
Clinical presentation Two-thirds of patients may be symptomatic. Patients present with localized pain and variable soft-tissue swelling. Constant or intermittent foot pain is most commonly along the plantar aspect. Upon physical examination, patients may present with the following: Focal tenderness Antalgic gait Pain with vibratory exam
临床表现
Imaging features Radiographs/CT: Central calcified nidus (cockade sign) Invariably occur within the neutral triangle Fat-attenuating lesion on CT Intraosseous lipomas appear as osteolytic lesions surrounded by a well-defined, thin sclerotic border. May be expansile if located within thin-caliber bones. Often are lobulated with internal osseous ridges. Characteristic radiographic pattern within the calcaneus.
MRI: Intraosseous lipomas show increased signal on T1- and T2-weighted images and are isointense to subcutaneous fat. They demonstrate fat suppression. They may have centrally decreased signal intensity consistent with a central calcified nidus. Internal fat necrosis may present as low T1 signal and increased T2 signal.
影像表现 平片/CT: 中心钙化灶（帽徽征）； 病变总是位于跟骨中央三角； CT上呈脂肪密度； 溶骨性病变，边界清楚，薄硬化边； 如果病变位于较薄的骨内，可表现为膨胀性； 常因内部骨嵴表现为分叶状； 跟骨内病变具有特征性影像表现。
MRI： T1WI呈高信号，T2WI上与皮下脂肪信号一致； 表现为脂肪抑制； 病变中心可见低信号，与中心钙化巢相一致； 内部脂肪坏死可表现为T1低信号，T2高信号。
Differential diagnoses Simple cyst Aneurysmal bone cyst Unicameral bone cyst Bone infarct
鉴别诊断：
Treatment Treatment is conservative management if the patient is stable and asymptomatic. Surgical intervention is considered in cases of symptomatic lesions or failed conservative management. Excision with curettage and bone graft packing is the treatment of choice. Recurrence is unlikely after excision. 治疗 患者病情稳定无明显症状时采取保守疗法： 有症状时可手术治疗，采取刮除及骨移植填充的治疗方法，切除后几乎没有复发的可能。
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