An unusual case of osteoid osteoma clinically mimicking sacroiliitis

Abstract

Osteoid osteoma is one of the unusual causes of musculosceletal pain. A case of a 21-year-old man who had low back and hip pain radiating to the posterior thigh for 3 years is presented. Pain was worse at night but reduced with the use of nonsteroidal anti-inflammatory drugs. Straight leg raising test was negative. Patrick-Fabere and sacroiliac compression tests were positive on the right. Neurological examination was normal. Lumbar spinal and pelvic radiographs were normal except for sclerosis at the inferior half of the iliac bone adjacent to the right sacroiliac joint. Sedimentation rate, C-reactive protein, and whole blood counts were normal. Bone scan showed nonspecific increased uptake. Computed tomography revealed the presence of diffuse sclerosis at inferior half of the right iliac bone extending to medial border of sacroiliac joint with subcortical osteolytic region and centrally hyperdense sclerotic nidus inside.

Spinal Osteoid Osteoma Associated With Soft Tissue Changes as a Challenging Diagnosis: A Review of the Literature

“…However, in some patients long standing abdominal or thorax wall pain or pelvic pain mimicking sacroiliitis may be unique symptom according to the level of the lesion (22,23). In the series by Ozaki et al (24) 2 of 9 cases and in the series by Raskas et al (25) 7 of 11 patients had radicular pain.…”

“…Some authors suggest that the cause of synovitis and nonspecific arthritis that occurred in the OOs located adjacent joints is also prostaglandin release from osteoma. Duman et al (22) reported a sacral OO located adjacent the sacroiliac joint causing pain mimicking sacroiliitis.…”

“…Even in the cases whose initial CT scan is normal, the nidus can be seen by bone scanning, and a repeated thin sectioned (2 mm) CT can show the lesion (31). Although there are some cases who had false negative bone scanning in literature (32), bone scan has high sensibility in diagnosis of OO, but low specificity (22). Particularly, spondylolysis, another frequently seen lesion in young population, may cause misdiagnosis (33).…”

“…Particularly, spondylolysis, another frequently seen lesion in young population, may cause misdiagnosis (33). Presence of double density sign is more specific to OO in differentiation from spondylolysis (22). This sign is characterized by a focal hot spot of the nidus and an area of low peripheral radionuclide accumulation in the perinidal sclerotic bone.…”

Osteoid Osteoma of the Sacrum Mimicking Sacroiliitis: A Case Report

“…[1] In our patient, the diagnosis was delayed and treated as sacroiliitis at the beginning. In the literature, there is only one case report that was misdiagnosed as sacroiliitis, [6] and there was a three-year delay in that diagnosis. In that patient, direct radiography revealed sclerosis.…”