Osteoid osteomas: a pain in the night diagnosis

Abstract

Osteoid osteoma is a common benign bone-forming lesion that is composed of a nidus of vascular osteoid tissue and woven bone lined by osteoblasts. It is frequently associated with considerable surrounding inflammation. The diagnosis is usually straightforward when imaging reveals a radiolucent nidus surrounded by variable degrees of reactive sclerosis. However, the diagnosis can be elusive when osteoid osteomas occur in atypical locations, as they may have a nonspecific and misleading appearance on different imaging modalities, particularly on MRI. The purpose of this pictorial essay is to review the typical and atypical features of osteoid osteomas on different imaging modalities, and the appearance of osteoid osteomas in different locations. We also review growth disturbances caused by osteoid osteomas and potential mimickers, with imaging characteristics that can aid in diagnosis.

Calcaneal osteoid osteoma hidden by confusing symptoms in an 18-year-old basketball player: A case report

“…1 Because of complementary nonspecific symptoms in intra-articular or juxtaarticular osteomas (chronic articular pain, swelling, joint stiffness, contracture and limping), the delay in diagnosis is often more than one year. 1e3,5e7…”

“…The available therapeutic options are the conservative management of pain by NSAIDs or operative intervention. 1,5 This case report analyses the reasons for initial misdiagnosis (misleading previous sport injury and potential mimickers) and discusses the different conservative and operative therapeutic options.…”

“…2e5 This pathology usually affects children and young adults within the third decade, and males are from 2 to 3 times more affected than females. 1,3,6 Usually local pain worse at night and improved by NSAIDs, especially salicylates, are the main clinical presentation. 1,3,6,7 However, when the site of presentation of the tumor is intra or juxtaarticular (lesions surrounded by or very close to the joint capsule and synovium), it can mimic a more widespread disorder, due to chronic articular pain.…”

“…Less commonly, the pain is associated with symptoms like swelling, joint stiffness, contracture and limping. 1,2,6 Osteoid osteomas may heal spontaneously, but this process may take several years. The available therapeutic options are the conservative management of pain by NSAIDs or operative intervention.…”

The osteoid osteoma of the proximal phalanx; diagnosis and treatment

“…The tumor usually invades extra-articular zones of the long bones. The clinical presentation appears with night pain that responds to aspirin [1]. The reason for relieving obtained with aspirin and NSAIDs is suppression of inflammatory mediators expressed by the nidus of the tumor [2].…”