Lesions with Fluid-Fluid Levels 含液-液平面的病变

22 11月

1.What is the incidence of this finding?


2. Are you able to arrive at a specific diagnosis based on your observation?


3. What is the most likely cause of the fluid-fluid level?


4. Is this finding compatible with benignity?


Lesions with Fluid-Fluid Levels 含液-液平面的病变

Lesions with Fluid-Fluid Levels 含液-液平面的病变

Lesions with Fluid-Fluid Levels


  1. Nearly 3% of bone or soft tissue tumors show a fluid-fluid level.


2. No, fluid-fluid levels in bone or soft tissue tumors cannot be considered diagnostic of any particular tumor.


3. Prior hemorrhage within the lesion.


4. No, because it may be seen in osteosarcoma (classic and telangiectatic), malignant fibrous histiocytoma, and soft tissue sarcomas.



Keenan S, Bui-Mansfield LT: Musculoskeletal lesions with fluid-fluid level: A pictorial essay. J Comput Assist Tomogr30:517–524, 2006.

Van Dyck P, Banhoenacker FM, Vogel J, et al:Prevalence, extension and characteristics of fluidfluid levels in bone and soft tissue tumors. Eur Radiol16:2644–2651, 2006.


Musculoskeletal Imaging: THE REQUISITES, 3rd ed, p 418.


A fluid-fluidlevel is one of the most common observations during the evaluation of tumors ofthe bone and soft tissues. This may be noted on either computed tomography ormagnetic resonance imaging. These levels become apparent when a fluidcollection containing substances of different density is allowed to settle, andwhen the plane of imaging is perpendicular to the fluid level. Frequently butnot always, fluid-fluid levels indicate prior hemorrhage. This finding can beobserved in a wide variety of lesions:osseous and soft tissue masses, neoplastic or non-neoplastic lesions, malignantor benign neoplasms, and primary or metastatic malignancies. It may also beseen in tumoral calcinosis, with calcium-fluid levels. When a fluid-fluid levelis detected, in conjunction with clinical history, the differential diagnosisfor a lesion can often be limited to a few choices. Fluid-fluid levels werefirst reported to occur in aneurysmal bone cysts. However, fluid-fluid levelshave more recently also been associated with malignant neoplasms such astelangiectatic osteosarcoma, conventional osteosarcoma, and malignant fibroushistiocytoma of bone; benign neoplasms such as chondroblastoma, giant celltumor of bone, fibrous dysplasia, simple bone cyst, and osteoblastoma; and softtissue tumors including soft tissue hemangioma, synovial sarcomas, and othersoft tissue sarcomas.