Osteoid osteoma of the femur

Case contributed by Domenico Nicoletti , 11 Mar 2021
Diagnosis certain
Changed by Henry Knipe, 12 Mar 2021

Updates to Case Attributes

Presentation was changed:
A 18-year-old male footballFootball player presented with a six-month history of posterior thigh pain. While he related the onset of pain to playing football, he did not give a clear history of trauma. The pain reliably woke him from sleep (at about 4am) each night and was almost completely eliminated when he took oral ibuprofen before bed.
Age changed from 20 to 20 years.
Body was changed:

Osteoid Osteomaosteoma is a benign osteoblastic tumor that is usually less than 2 cm in size. It consists of a central vascularized nidus that represents the neoplastic tissue. The nidus is surrounded by normal reactive bone. It is most frequently found in long bones, such as the femur and tibia, but can occur at any site. Cortical thickening surrounding a small central core of lower density, the nidus, are the classical radiological finding.

X-rays may be normal; however, the cortical thickening is generally well visualised with this imaging modality. The central “nidus” is sometimes visible on x-rays as a well-circumscribed lucent region, occasionally with a central sclerotic dot. CT imaging considered to be the imaging modality of choice. On this imaging modality appearing as a focally lucent area within surrounding sclerotic reactive bone. In juxta-articular localisation, the reactive sclerosis may be absent.

Kayser et al. have classified osteoid osteoma into four categories according to the relation of the lesion with the bone cortex: subperiosteal (located on the external aspect of the cortex, surrounded by periosteal reaction), intracortical (located within the cortex), endosteal (on the internal of the cortex) and medullary (located within the medullary bone).

  • -<p>Osteoid Osteoma is a benign osteoblastic tumor that is usually less than 2 cm in size. It consists of a central vascularized nidus that represents the neoplastic tissue. The nidus is surrounded by normal reactive bone. It is most frequently found in long bones, such as the femur and tibia, but can occur at any site. Cortical thickening surrounding a small central core of lower density, the nidus, are the classical radiological finding. X-rays may be normal; however, the cortical thickening is generally well visualised with this imaging modality. The central “nidus” is sometimes visible on x-rays as a well-circumscribed lucent region, occasionally with a central sclerotic dot. CT imaging considered to be the imaging modality of choice. On this imaging modality appearing as a focally lucent area within surrounding sclerotic reactive bone. In juxta-articular localisation, the reactive sclerosis may be absent. Kayser et al. have classified osteoid osteoma into four categories according to the relation of the lesion with the bone cortex: subperiosteal (located on the external aspect of the cortex, surrounded by periosteal reaction), intracortical (located within the cortex), endosteal (on the internal of the cortex) and medullary (located within the medullary bone).</p>
  • +<p><a title="Osteoid osteoma" href="/articles/osteoid-osteoma">Osteoid osteoma</a> is a benign osteoblastic tumor that is usually less than 2 cm in size. It consists of a central vascularized nidus that represents the neoplastic tissue. The nidus is surrounded by normal reactive bone. It is most frequently found in long bones, such as the femur and tibia, but can occur at any site. Cortical thickening surrounding a small central core of lower density, the nidus, are the classical radiological finding.</p><p>X-rays may be normal; however, the cortical thickening is generally well visualised with this imaging modality. The central “nidus” is sometimes visible on x-rays as a well-circumscribed lucent region, occasionally with a central sclerotic dot. CT imaging considered to be the imaging modality of choice. On this imaging modality appearing as a focally lucent area within surrounding sclerotic reactive bone. In juxta-articular localisation, the reactive sclerosis may be absent.</p><p>Kayser et al. have classified osteoid osteoma into four categories according to the relation of the lesion with the bone cortex: subperiosteal (located on the external aspect of the cortex, surrounded by periosteal reaction), intracortical (located within the cortex), endosteal (on the internal of the cortex) and medullary (located within the medullary bone).</p>

Updates to Study Attributes

Findings was changed:

Rx right femur

Radiograph shows fusiform cortical thickening of the anterolateral cortex of the proximal femur.

Updates to Study Attributes

Findings was changed:

CT right femur without contrast

Ther’sThere is a small intracortical osteolytic lesion without central calcification, surrounded by a prominent zone of reactive sclerosis due to a periosteal and endosteal reaction.

Updates to Study Attributes

Findings was changed:

MRI right femur with contrast

MR T1 coronal image demonstrates the wide cortical thickening. T1-weighted images show the low-signal-intensity nidus, which has strong enhancement. STIR images shows a intracortical osteoid osteoma of the right proximal femur, with inflammatory reaction in the adjacent cancellous bone and in the soft tissues.

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