Thursday, February 4, 2010

Button Sequestrum

A round radiolucent skull defect with a central bony density is referred to as a button sequestrum. This finding can be seen in the following cases, but is an uncommon appearance in all (bold indicates classic cases)
  • Langerhans cell histiocytosis: Classic description. Most commonly affects the skull.
  • Osteomyelitis
  • Fibrosarcoma
  • Lymphoma
  • Partially calcified intraosseous lipoma
  • Tuberculous osteitis
  • Radiation necrosis
  • Metastatic carcinoma: Especially breast
  • Fibrous dysplasia
  • Epidermoid and dermoid cysts
  • Hemangioma: Mimics button sequestrum.
  • Meningioma
  • Paget disease
  • Multiple myeloma
  • Syphilis
  • Sarcoidosis


  • Gamuts in Radiology - Reeder and Felson - 4th ed (Springer, 2003).
  • Krasnokutsky MV. The button sequestrum sign. Radiology. 2005 Sep;236(3):1026-7.
  • Satin R, Usher MS, Goldenberg M. More causes of button sequestrum. J Can Assoc Radiol. 1976 Dec;27(4):288-9.

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