A hole in the bone
Author: BuMin Kong, MD; Susie Lee, BA
Peer-Reviewer and Final Editor: Mark Hopkins, MD
A 16 year old male presents with right mid thigh pain for 2 weeks. The pain is constant, dull, and worse at night but improves with ibuprofen. He denies any trauma and is able to ambulate without difficulty.
Image 1. Case courtesy of Dr Iqbal Naseem, Radiopaedia.org, rID: 22828
What is your diagnosis?
Osteoid Osteoma
Image 1 shows a central, translucent nodule called a nidus which is surrounded by cortical thickening known as reactive sclerosis. A nidus and reactive sclerosis are pathognomonic for osteoid osteoma, especially in the right patient population
Image 2. Translucent nodule and cortical thickening seen on the right medial proximal tibia.
Case courtesy of Dr. Jeremy Jones, Radiopaedia.org, rID: 6131. Annotation by authors
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Pearl: Osteoid osteomas are small, benign bone tumors that present in young patients ages 5-25 and are typically less than 2cm. They classically present with progressive, constant pain that worsens at night and is more common in men than women [1].
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Pearl: These lesions are most commonly found in the femur, followed by the tibia and spine [1].
Reference
[1] Tepelenis, Kostas et al.“Osteoid Osteoma: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features, and Treatment Option.” In vivo (Athens, Greece) vol. 35,4 (2021): 1929-1938. doi:10.21873/invivo.12459
[2] Pettine KA, Klassen RA. Osteoid-osteoma and osteoblastoma of the spine. J Bone Joint Surg Am. 1986;68(3):354–361.
[3] M. Feletar, S. Hall, Osteoid osteoma: a case for conservative management, Rheumatology, Volume 41, Issue 5, May 2002, Pages 585–586, https://doi.org/10.1093/