Pain is often difficult to localize, so radiographic evaluation often must include several areas.

     Blastic lesions tend to be rounded areas of increased density representing pathologically increased osteoblastic activity. Lesions are usually multiple and located axially; only lung cancer commonly causes bony metasteses distal to the knee or elbow.

     Pathologic fracture is rare but can occur if the lesions are large and involve the cortex, as the bone laid down is abnormal and less strong than normal mature cortical bone.