Wolfgang Hirsch (Halle)  

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10 Years  

Male  

10 year-old boy. For 3 months he complains of moderate pain in the lower leg region. Pain occurred in variable intensity during the day, but particularly at night. Treatment so far: immobilization.  

Osteoid osteomas are, beside fibrotic cortical defects and osteomas, the third most frequent benign bone change of youth. It appears more frequently in boys than in girls. Usually, it is localized in the proximal femur, but it can also be frequently found in the tibia and in the spinal column. Also, all other bones (phalanges) can be afflicted. Nightly bone pain is typical as well as the prompt diminishing of pain when treated with aspirin.

Centrally one finds the nest; the nest cavity is often hypervascularized. Surrounding reaction: Hyperostosis with often distinct asymmetrical cortical thickening.

 

<- view X-ray 1

X-ray 1: one-sided cortical thickening of the tibia. One circumscribed, lytic change cann not be proven in this x-ray image.


<- view MRI 1

MRI 1: T1 with fat saturation, transversal: in the dorsolateral area of the tibia within the cortical hyperostosis, a little, non-enhancing nidus and a border with contrast-uptake is seen.


<- view MRI 2

MRI 2: T2 with fat saturation: distinct bone edema and surrounding soft-tissue edema. Representation of the nidus.


<- view CT 1

CT 1: transversal: representation of the nidus.


<- view CT 2

CT 2: sagittal Reformation: representation of the nidus

Surgery / Histo  

No differential diagnoses if the nidus is obvious. Otherwise Ewing sarcoma, osteomyelitis, cortical irregularity syndrome  

Surgery is usually needed (after markings in CT). Other treatment approaches are being discussed.  

N/A  

N/A  

N/A  

Leg-Bones  

neoplastic