Intra-Articular Osteoid Osteoma Mimicking Juvenile Arthritis

Traore, Sidi Yaya; Dumitriu, Dana; Docquier, Pierre-Louis

doi:10.1155/2014/912609

Cited by 16 publications

(23 citation statements)

References 12 publications

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“…CRMO and JIA were initially considered in our patient, and he was treated accordingly. Intra-articular OO mimicking JIA has been previously described in few cases [ 12 , 13 ]. To our knowledge, we are the first to report a case of acetabular OO with similar presentation to CRMO.…”

Section: Discussionmentioning

confidence: 99%

Acetabula Osteoid Osteoma Mimicking Juvenile Idiopathic Arthritis and Chronic Recurrent Multifocal Osteomyelitis

Baky

Thomas

Kuechle

et al. 2020

Case Reports in Rheumatology

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Osteoid osteoma (OO) is a benign bone tumor that usually presents between 10 and 35 years of age. The metaphysis and diaphysis of the femur and tibia are the typical locations. The diagnosis is usually straightforward when images reveal a radiolucent nidus surrounded by reactive sclerosis. However, the diagnosis is more difficult when it occurs at atypical locations with nonspecific and misleading appearance on images. OO may mimic juvenile idiopathic arthritis (JIA), bone infection, or malignancy. We present a 14-year-old male with a 4-month history of left hip pain. His pain was worse with playing hockey and lacrosse and in the morning and sometimes woke him up at night. His examination was significant for pain with flexion and external rotation of the left hip and for mild limitation of full external rotation. Blood work revealed normal complete blood count, erythrocyte sedimentation rate, and C-reactive protein. Left hip X-ray was unremarkable. Left hip MR arthrogram showed marked edema of the medial and posterior walls of the left acetabulum. CT-guided biopsy of the left acetabulum showed unremarkable flow cytometry and chronic inflammatory component raising concern about chronic recurrent multifocal osteomyelitis (CRMO). Bone scan revealed focal increased uptake in the left acetabulum and no additional abnormality. Repeat MRI with intravenous contrast showed a left hip effusion, focal synovial enhancement in the medial left hip, and acetabula edema. The patient failed treatment for presumed JIA and CRMO with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, methotrexate, and adalimumab. CT scan of the left hip was performed for further evaluation of the bone and showed 11 × 6 mm low attenuation focus with subtle internal nidus in the posteromedial aspect of the acetabular rim, suggestive of intra-articular OO. Radiofrequency ablation was performed with no complications, and the left hip pain improved. The atypical location resulted in delay of diagnosis for 12 months after presentation. We highlight the diagnostic pitfalls observed in atypical OO locations and the difficulties this creates with making the diagnosis. OO mimicking JIA has previously been described. We submit CRMO as another differential diagnosis which may be mimicked and demonstrate the vital role of CT scan in the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Acetabula Osteoid Osteoma Mimicking Juvenile Idiopathic Arthritis and Chronic Recurrent Multifocal Osteomyelitis

Baky

Thomas

Kuechle

et al. 2020

Case Reports in Rheumatology

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“…The typical MRI findings of early-stage lumbar spondylolysis are high signal intensity on fat-suppressed T2-weighted images in the pedicle or pars, or both [ 12 ]. By contrast, MRI findings of the nidus are typically low signal intensity on T1- and T2-weighted images with surrounding bone marrow edema [ 18 ]. The nidus could not be detected because of its small size and the low signal intensity, which is often masked by the associated perilesional edema surrounding the nidus [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, MRI findings of the nidus are typically low signal intensity on T1- and T2-weighted images with surrounding bone marrow edema [ 18 ]. The nidus could not be detected because of its small size and the low signal intensity, which is often masked by the associated perilesional edema surrounding the nidus [ 18 ]. In the present osteoid osteoma at the pars inter-articularis, fat-suppressed T2-weighted images of the MRI depicted bone marrow edema extending from the pedicle to the spinal process, which is an unusual finding for spondylolysis.…”

Section: Discussionmentioning

confidence: 99%

Osteoid Osteoma Can Occur at the Pars Interarticularis of the Lumbar Spine, Leading to Misdiagnosis of Lumbar Spondylolysis

et al. 2018

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Patient: Male, 18Final Diagnosis: Osteoid osteomaSymptoms: Low back painMedication: —Clinical Procedure: OperationSpecialty: Orthopedics and TraumatologyObjective:Rare diseaseBackground:Osteoid osteomas are benign bone-forming tumors characterized by local inflammation and pain. They are also characterized by a small osteolytic lesion (nidus). Spondylolysis is a defect of the pars interarticularis, which may lead to stress fractures, and is a common cause of low back pain in adolescence. Osteoid osteoma occurs predominantly in the posterior elements of the spine. Magnetic resonance imaging (MRI) signal abnormality suggesting bone marrow edema is a common finding in osteoid osteoma and early-stage spondylolysis without prominent defect.Case Report:An 18-year-old male was suffering from low back pain. He was diagnosed with lumbar spondylolysis on initial MRI and computed tomography (CT). Subsequent thin-slice CT demonstrated a nidus at the pars interarticularis, and variously-sliced MRI could detect widespread bone marrow edema. On the diagnosis of an osteoid osteoma, the nidus and surrounding osteosclerosis were resected. The patient’s pain disappeared after surgery.Conclusions:Osteoid osteoma in the pars interarticularis can be difficult to diagnosis, because MRI and CT findings for osteoid osteoma at the pars interarticularis are similar to those of the lumbar spondylolysis. The possibility of osteoid osteoma should be kept in mind when examining adolescents with low back pain.

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“…'nın (10) 4 olguluk serisinde yanlışlıkla juvenil artrit tanısı konulup buna yönelik medikal tedavi verilen 4 hastanın OO tanısını alması 4 ile 7 ay arasını bulmuştur (10). Osteoartiküler ağrılarda, kolay ulaşılabilir, hızlı, noninvaziv ve maliyeti düşük olması nedeniyle hemen her zaman ilk görüntüleme yöntemi direkt radyografidir.…”

Section: Discussionunclassified

An Osteoid Osteoma in the Proximal Femur with Unilateral Lower Extremity Atrophy Caused by Delay in Diagnosis: A Case Report

Yetişgin¹,

Boyacı²,

Tutoğlu³

et al. 2016

Tod

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SummaryOsteoid osteoma is one of the rare benign bone tumors that seen more often at childhood and young adults. Delay in diagnosis is commonly seen and it leads to development of several complications. In this case, we reported a 10-year-old child with osteoid osteoma located in right proximal femoral diaphysis. He had a right femoral pain and thigh atrophy for one year and could not be diagnosed in this period, and we discussed the causes of delay in diagnosis, points to be considered in the diagnosis and treatment options. Keywords: Osteoid osteoma, lower extremity atrophy, proximal femur, radiofrequency ablation Osteoid osteoma, çocuk ve genç erişkin dönemde daha sık rastlanan, nadir görülen benign kemik tümörlerindendir. Tanıda gecikmelere sıklıkla rastlanıp buna bağlı çeşitli komplikasyonlar görülebilmektedir. Bu yazıda 10 yaşında, 1 yıldır sağ uyluk ağrısı nedeniyle birçok tetkik yapılıp tanı konulamamış ve sağ bacak atrofisi gelişmiş, femur proksimalinde yerleşmiş osteoid osteoma tanısı koyduğumuz bir olguyu sunarak hastalığın tanısında gecikme nedenleri, tanı yöntemlerinde dikkat edilmesi gereken noktalar ve tedavi seçeneklerini tartıştık. Anahtar kelimeler: Osteoid osteoma, alt ekstremite atrofisi, proksimal femur, radyofrekans ablasyon Öz 145 GirişOsteoid osteoma (OO), erkek cinsiyet baskınlığı olan, çocuk ve genç erişkin yaş grubunda daha sık görülen benign bir kemik tümörüdür (1). Benign kemik tümörlerinin yaklaşık olarak %12'sini oluşturan bu grup hastalık, uzun kemiklerin korteksini tutma eğiliminde olup olguların %50'den fazlası femur veya tibia diyafizinde yerleşmişken en sık etkilenen bölge proksimal femurdur (2,3). Olguların %90'dan fazlası 25 yaşından küçük olan bu hastalardaki en sık semptom olan kemik ağrısı, tipik olarak fiziksel aktivitelerle ilişkisiz, geceleri artan ve steroid olmayan antiinflamatuvar ilaçlara (SOAİİ) iyi yanıt veren, lokal keskin bir vasıftadır (4). Belirtilerin başlangıcı ile doğru tanı koyma arasındaki süre nadiren 6 aydan kısa olmakla beraber, yıllara dahi uzayabilir (5,6). Tanıda gecikme fokal nörolojik hastalıkları düşündürecek düzeyde bulgu ve komplikasyonların gelişmesine yol açabilir. Bu yazıda geç tanıya bağlı unilateral alt ekstremite atrofisi ile başvuran bir OO olgusu sunmayı ve literatür eşliğinde hastalığın tanı yöntemleri, tanıda gecikme nedenlerini ve tedavi seçeneklerini vurgulamayı amaçladık. Olgu SunumuOn yaşında kız hasta, 1 yıldır devam eden sağ kasık ve proksimal uyluk bölgesinde ağrı şikayeti ile polikliniğimize başvurdu. Ağrıya bağlı yürüme güçlüğü ve sağ bacakta incelmenin de eşlik ettiği güçsüzlük tarifliyordu. Geceleri artan ağrısının oral salisatlar ile rahatladığı öğrenildi. Sağ antaljik yürüme paterni olan hastanın nörolojik muayenesi normal olmakla beraber sağ uylukta 1,5 cm, baldırda ise 1 cm atrofi mevcuttu. Ağrı yeri olarak sağ kasık ve uyluk proksimalini gösteren hastanın sağ kalça iç rotasyon sonu hafif ağrıyla birlikte kısıtlıydı. Vertebral veya paravertebral hassasiyeti olmayan hastanın düz bacak kaldırma ve femoral germe testleri ...

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Intra-Articular Osteoid Osteoma Mimicking Juvenile Arthritis

Cited by 16 publications

References 12 publications

Acetabula Osteoid Osteoma Mimicking Juvenile Idiopathic Arthritis and Chronic Recurrent Multifocal Osteomyelitis

Acetabula Osteoid Osteoma Mimicking Juvenile Idiopathic Arthritis and Chronic Recurrent Multifocal Osteomyelitis

Osteoid Osteoma Can Occur at the Pars Interarticularis of the Lumbar Spine, Leading to Misdiagnosis of Lumbar Spondylolysis

An Osteoid Osteoma in the Proximal Femur with Unilateral Lower Extremity Atrophy Caused by Delay in Diagnosis: A Case Report

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