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Bedoya MA, Iwasaka-Neder J, Tsai A, Bixby SD. Intra-articular Osteoid Osteomas: Imaging Manifestations and Mimics. Radiographics 2024; 44:e230208. [PMID: 38843097 DOI: 10.1148/rg.230208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Osteoid osteoma (OO) is the third most prevalent benign bone neoplasm in children. Although it predominantly affects the diaphysis of long bones, OO can assume an intra-articular location in the epiphysis or the intracapsular portions of bones. The most common location of intra-articular OO is the hip joint. The presentation of intra-articular OOs often poses a diagnostic enigma, both from clinical and radiologic perspectives. Initial symptoms are often vague and nonspecific, characterized by joint pain, stiffness, and limited range of motion, which frequently contributes to a delayed diagnosis. Radiographic findings range from normal to a subtle sclerotic focus, which may or may not have a lucent nidus. In contrast to their extra-articular counterparts, intra-articular lesions have distinct features at MRI, including synovitis, joint effusion, and bone marrow edema-like signal intensity. While CT remains the standard for identifying the nidus, even CT may be inadequate in visualizing it in some cases, necessitating the use of bone scintigraphy or fluorine 18-labeled sodium fluoride PET/CT for definitive diagnosis. Radiologists frequently play a pivotal role in suggesting this diagnosis. However, familiarity with the unique imaging attributes of intra-articular OO is key to this endeavor. Awareness of these distinctive imaging findings of intra-articular OO is crucial for avoiding diagnostic delay, ensuring timely intervention, and preventing unnecessary procedures or surgeries resulting from a misdiagnosis. The authors highlight and illustrate the different manifestations of intra-articular OO as compared with the more common extra-articular lesions with respect to clinical presentation and imaging findings. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- M Alejandra Bedoya
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Jade Iwasaka-Neder
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Andy Tsai
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Sarah D Bixby
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
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He Y, Li X, Tu ZX, Chen HW, Zeng H, Peng Q, Chen TZ. Arthroscopic treatment of osteoid osteoma in the posterior proximal tibia: A case report and literature review. Medicine (Baltimore) 2024; 103:e37076. [PMID: 38306554 PMCID: PMC10843490 DOI: 10.1097/md.0000000000037076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Osteoid osteoma (OO) is a benign lesion characterized by an increased fibrous component in the bone marrow, presence of bone-like structures within the medullary cavity, and a surrounding sclerotic bone rim. Reports on OO located in the posterior proximal tibia are rare. CASE SUMMARY Herein, we report the case of an 18-year-old male, admitted for the evaluation of right knee pain. The right knee pain had started 6 months prior without any apparent cause, which was notably severe at night, affecting sleep, and was exacerbated while climbing stairs or bearing weight. The patient also experienced pain on flexion. Three-dimensional computed tomography and magnetic resonance imaging revealed a nodular lesion beneath the cortical bone of the posterior medial plateau of the right tibia and an abnormal signal focus on the posterior lateral aspect of the right tibial plateau associated with extensive bone marrow edema. A small amount of fluid was present in the right knee joint capsule. The patient subsequently underwent arthroscopic excision of the OO. Postoperatively, there was significant relief of pain, and the knee range of motion returned to normal. CONCLUSION Although OO in the posterior proximal tibia is a rare occurrence, it can be effectively excised through minimally invasive arthroscopic visualization.
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Affiliation(s)
- Yinhao He
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Xiaosheng Li
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Zhi-Xing Tu
- Fujian Medical University, Fuzhou, Fujian Province, China
| | - Hong-Wen Chen
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Hui Zeng
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Qiang Peng
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Tie-Zhu Chen
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
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Chen C, Fu S, Su Y, Shi Z. Intra-articular Osteoid Osteoma of the Intermediate Cuneiform Bone Causing Articular Degeneration: A Rare Case and Literature Review. Orthop Surg 2023; 15:2471-2476. [PMID: 37431565 PMCID: PMC10475673 DOI: 10.1111/os.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 07/12/2023] Open
Abstract
Osteoid osteoma of the cuneiform bone is an exceedingly rare and easily missed cause of foot pain. The uncharacteristic and nonspecific radiographs of such intra-articular osteoid osteoma further increase difficulty in making the diagnosis. To date, there has been no description of intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration in any published literatures. We present a case of intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration, who underwent curettage, allograft bone graft, and navicular-cuneiform arthrodesis. The patient presented with radiographic bone union, full motor function recovery and pain-free at the 22-month follow-up. This report adds to the existing literature. Intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration is an exceedingly rare and easily missed cause of foot pain. It proves a complicated and challenging task to identify intra-articular osteoid osteoma. Clinicians should be particularly careful not to exclude the possibility of arthritis and, thus, vigilant when choosing the surgical option.
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Affiliation(s)
- Cheng Chen
- Foot & Ankle Section, Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth Peoples HospitalShanghaiChina
| | - ShaoLing Fu
- Foot & Ankle Section, Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth Peoples HospitalShanghaiChina
| | - Yan Su
- Foot & Ankle Section, Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth Peoples HospitalShanghaiChina
| | - ZhongMin Shi
- Foot & Ankle Section, Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth Peoples HospitalShanghaiChina
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Gurel R, Shehadeh K, Elbaz E, Benady A, Factor S, Ashkenazi I, Gortzak Y, Sternheim A, Dadia S, Segal O. Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the upper extremity: A series of 19 cases. J Orthop Surg (Hong Kong) 2023; 31:10225536231217123. [PMID: 37976541 DOI: 10.1177/10225536231217123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The surgical treatment for osteoid osteoma (OO) in the upper extremity is challenging due to the difficulty in locating the lesion and the crowding of sensitive structures within the anatomy. This study aimed to describe the outcomes of navigated minimally invasive radiofrequency ablation and those of navigated mini open-intralesional curettage in treating these lesions. Nineteen consecutive patients with OO in the upper limb who underwent navigated surgery were included. The average QuickDASH and Numeric Pain Rating Scale improved from 62.2 ± 23.7 to 11.7 ± 16.9 and from 8.1 ± 1.6 to 0.5 ± 1.8, respectively (p < .01 each) following the procedure. Two complications were recorded: one patient had persistent radial nerve palsy, and one patient had transient partial radial nerve weakness. In conclusion, navigation is an important tool in the surgical treatment of OO in the upper limb. A mini open approach to identify and protect neurovascular structures is recommended.
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Affiliation(s)
- Ron Gurel
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Kathrine Shehadeh
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Itay Ashkenazi
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ortal Segal
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
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Civino A, Diomeda F, Giordano L, Damasio MB, Perrone S, Gallizzi R, Ravelli A, Piscitelli P, Maggio MC. Intra- and Juxta-Articular Osteoid Osteoma Mimicking Arthritis: Case Series and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050829. [PMID: 37238377 DOI: 10.3390/children10050829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Intra- and juxta-articular osteoid osteomas are rare, representing less than 10% of all osteomas. Compared to the classic diaphyseal or metaphyseal site of long bones, they often have an atypical onset, a longest diagnostic delay, and frequent initial misdiagnoses, with pictures that can mimic inflammatory monoarthritis. We aimed to describe a case series, and to provide a literature review of this uncommon and misleading tumor location. METHODS We performed a retrospective analysis of patients referred to three pediatric rheumatology centers, with a final diagnosis of articular osteoid osteoma. A review of the literature was additionally conducted. RESULTS We included 10 patients with a mean age of 14 years. All patients with unusual sites (olecranon fossa, lumbar vertebra, distal phalanx of the toe, fibula) had a misdiagnosis, and cases with initial suspicion of monoarthritis had the longest diagnostic delay, up to 24 months. The literature review confirms the significant risk of misdiagnosis, and an average time from symptom onset to diagnosis ranging from 0.4 to 1.8 years. CONCLUSIONS Articular osteoid osteoma may mimic arthritis, especially in adolescence. Knowledge of the atypical forms of presentation, and of the clinical and radiological pitfalls, reduces the risk of diagnostic error.
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Affiliation(s)
- Adele Civino
- Pediatric Rheumatology and Immunology Unit, "Vito Fazzi" Hospital, 73100 Lecce, Italy
| | - Federico Diomeda
- Pediatric Rheumatology and Immunology Unit, "Vito Fazzi" Hospital, 73100 Lecce, Italy
| | - Luca Giordano
- Department of Radiology, "Vito Fazzi" Hospital, 73100 Lecce, Italy
| | | | - Sandra Perrone
- Department of Radiology, "Cardinale G. Panico" Hospital, 73039 Tricase, Italy
| | - Romina Gallizzi
- Pediatric Unit, Department of Health Science, Magna Grecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Angelo Ravelli
- Scientific Direction, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genova, 16147 Genova, Italy
| | - Prisco Piscitelli
- Department of Biological and Environmental Sciences and Biotechnologies, University of Salento, 73100 Lecce, Italy
- Health Authority, ASL LE, 73100 Lecce, Italy
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