An adolescent male presented with complaint of pain in the left hip, which is relieved by analgesics.
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Diagnosis: Osteoid osteoma
Plain radiograph (Figure 1) shows a tiny lucency in the region of the left femoral neck with adjacent periosteal reaction. The finding is confirmed on CT (Figure 2), which shows a small lucent lesion in the left femoral neck with adjacent periosteal reaction. The lesion is PET avid (Figure 3). MRI STIR images confirm the small lesion in the left femoral neck with significant adjacent marrow edema.
• Benign bone forming tumors
• Present with complaint of nocturnal pain, which is relieved by analgesics
• Adolescent males are commonly affected
• Small lucent nidus with adjacent solid periosteal reaction affecting long tubular limb bones, proximal femur being the most common site
• Plain radiograph
○ Solid periosteal reaction with thickened cortex
○ Nidus may be seen as small lucency
○ Lucent lesion <2 cm with adjacent solid periosteal
○ A central sclerotic dot may be seen within the lucency
• Nuclear medicine
○ Intense focal uptake on bone scan
○ Double density sign: intense central uptake surrounded by lesser degree of uptake in the adjacent bone
○ Shows adjacent marrow edema, however the nidus may not be seen well
Management includes surgical resection or radiofrequency ablation.
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2. Berry M. Diagnostic Radiology: Musculoskeletal and Breast Imaging Hardcover – 2005. New Delhi: Jaypee Bros. Medical Publishers; 2005.
3. Yochum T Rowe L. Yochum and Rowe's essentials of skeletal radiology. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2005.