Osteoid osteoma

Case contributed by Dr Mohammad A. ElBeialy


A limping child with left hip pain.

Patient Data

Age: 9 years
Gender: Male

CT scout shows no evident abnormality.

  • Left femoral neck anterior cortex small well defined intra-cortical lytic lesion measuring about 4.5 mm with central sclerotic focus (nidus) surrounded by thin sclerotic rim and mild cortical thickening.
  • No fracture line seen.
  • Intact both hip joint. No evidence of slipped capital femoral epiphysis or  perthes disease.
  • Intact peri-articular musculature.

Case Discussion

Typical radiological features of osteoid osteoma with cenral vascular sclerotic nidus surrounded by lucent area and thin sclerotic rim (double density sign). The patient gave a typical history of night pain that is relieved by salicylates. 

Plain x-ray shows no definite abnormality. MRI (not shown) shows focal left femoral neck anterior cortex non-specific marrow edema.

The main differential diagnosis is a Brodie's abscess - oval shaped lytic lesion along the long axis of the bone with dense sclerotic margin, no nidus, no double density sign. Osteoblastoma is a large osteoid osteoma (larger than 2 cm).   

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Case information

rID: 30812
Published: 4th Sep 2014
Last edited: 16th Dec 2015
Inclusion in quiz mode: Included

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