The first step in creating a differential for a radiographic lesion is to develop a detailed radiographic description and history. A radiographic description should include:
- Precise location
- Radiolucent, radiopaque, mixed
- Relationship to adjacent structures
The patient's history can also be key in getting closer to a diagnosis. Factors like onset, associated symptoms and rate of progression, or even demographics can help distinguish one condition from another. This can also help narrow down what type of pathological process is suspected (variant of normal, genetic, reactive, infection, neoplasm, or manifestation of systemic disease).
Here are some key terms that can be used to describe radiographic lesions:
The following is a table outlining radiographic lesions you could encounter on the INBDE along with key characteristics and an example radiograph. It is important to keep in mind that all conditions have variations and the characteristics listed, while common, may not occur in every case. This is meant to serve as a guide in thinking about how you approach questions with radiographic lesions and there may be other methods of categorization that work better for you.
By starting with the history you can narrow down the type of condition. For example, if there is a history of trauma we would suspect a reactive condition. If a condition is rapidly progressing and associated with paresthesia, we would suspect malignancy.
Making note of key “unique” characteristics can also be helpful for exam preparation, such as “sunburst” appearance associated with osteosarcoma, or discrete mixed lesion in anterior mandible region leads us to consider periapical cemento-osseous dysplasia.