MRI of the spine in a 14-year-old girl with acute back pain shows a vertebral body lesion that is expansile and contains multiple locules with fluid-fluid levels on T2-weighted images. What is the most likely diagnosis?

• A Aneurysmal bone cyst ✓
• B Eosinophilic granuloma
• C Giant cell tumor
• D Metastasis

Explanation

Fluid-fluid levels within expansile multiloculated cystic spaces are the hallmark of aneurysmal bone cyst, reflecting layering of blood products of differing ages within cavernous spaces. It commonly involves the posterior elements of the spine in children and adolescents. Giant cell tumor may show secondary ABC-like change but is centred in the epiphysis after physeal closure. Metastasis is rare in this age group, and eosinophilic granuloma gives a vertebra plana rather than an expansile multicystic lesion.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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