Osteoid Osteoma

Case History: A 17-year-old male with hip pain

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Image 1: AP view

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Image 2: Elongated femoral neck view

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Image 3: Coronal IR sequence

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Image 4: Surface coil high resolution, proton density, sagittal sequence

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Image 5: Surface coil high resolution, proton density, axial sequence

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Image 6: Axial CT image through the femoral neck

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Image 7: Three hour delayed spot images, Tc99 mDP bone scan

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Image 8: SPECT axial image, Tc99 mDP bone scan

Findings: Radiographs demonstrate a subtle loss of the normal femoral head neck offset but no focal lesion. MRI demonstrates marrow edema of the right femoral neck and a joint effusion. Subtle low signal focus is seen on the axial image and a labral tear is present on the sagittal sequence. CT demonstrates a subtle lucent focus of the anterior femoral cortex and there is increased activity focally at this location on the bone scan.

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Image 9: Surface coil high resolution, proton density, sagittal sequence

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Image 10: Surface coil high resolution, proton density, axial sequence

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Image 11: Osteoid osteoma

Diagnosis: Osteoid Osteoma

Discussion: Bony lesion of osteoid and immature bone that incites an adjacent reactive bony/inflammatory response secondary to prostoglandin release. Typically in younger patients (5-25 ) and with a classic clinical pattern of night time pain alleviated with aspirin. Classified as cortical, cancellous, and subperiosteal. This case presents the rarest type, a subperiosteal lesion. Current standard of care is radiofrequency ablation if possible or resection.

Resources:

• Resnick and Kransdorf. Bone and Joint Imaging. 2005.
• http://bonetumor.org/tumors/pages/page13.html
• Lee, EH. Osteoid osteoma: A current review.
• J Pediatr Orthop. 2006 Sep-Oct;26(5):695-700.

Case courtesy Hospital for Special Surgery. ©2013 Hospital for Special Surgery.
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