Flat and irregular bones have anatomic subdivisions comparable to long bones. This concept is useful in the radiograpic evaluation of solitary bone lesions. Areas adjacent to cartilage are metaphyseal-equivalent locations. Prior to skeletal maturation, metaphyseal-type vascular anatomy predisposes these sites to involvement by hematogenous osteomyelitis. Approximately 30% of cases of hematogenous osteomyelitis affect these metaphyseal-equivalent sites and often present difficult diagnostic challenges. Forty-nine patients with this condition are described.