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Osteoid Osteoma

Archie R McGowan, MD
J Stevan Nagel, MD

March 5, 1996

Presentation

A 30-year-old man presented to his primary care physician with a complaint of right leg pain of one year's duration. The pain was worse at night but was fully relieved by aspirin. There is no history of trauma.

Imaging Findings

Plain radiograph of right tibia and fibula
Bone scintigraphy

A plain radiograph of the right tibia and fibula reveals a focally sclerotic expanded area of the tibial cortex without overlying soft tissue or periosteal abnormalities (arrow). A radiolucent nidus is visible in the center of the focal area of sclerosis.

Radionuclide bone scintigraphy using technetium-99m MDP (methylene diphosphonate) reveals a very prominent focal uptake of the radiotracer in the same region seen to be sclerotic on plain radiograph (arrow). Of note is the "double density" scintigraphic appearance of the more focally active central region and the surrounding halo of activity (arrow).

Differential Diagnosis

Osteoid osteoma
Stress fracture
Trauma
Osteogenic sarcoma

Diagnosis

Osteoid osteoma

Discussion

Osteoid osteoma is characteristically found in the femur, tibia, talus spine and humerus, usually in the diaphysis or metaphysis of these bones. This is a benign bone tumor with a central small nidus of osteoid which incites a vigorous reaction in surrounding tissue. The common presentation is one of pain unrelated to activity or most pronounced after drinking alcohol. The pain is often relieved with nonsteriodals. Osteoid osteoma is most common between 7 and 25 years of age and is three times more common in males.

Three types of osteoid osteomas exist; categories are based on location:

  1. Cortical location is the most common with a dense sclerotic reaction disguising the nidus.
  2. Medullary locations, often in the femoral neck or bones of the hands or feet, are less common where osteosclerosis is minimal to moderate.
  3. Subperiosteal is the rarest form with little or no reactive sclerosis making it a more difficult to diagnose radiographically.

The plain film findings as well as the "double density" appearance on the nuclear medicine study represent cortical osteoid osteoma.

References

1. Brant WE, Helms C. Fundamentals of diagnostic radiology. Philadelphia:Williams and Wilkins, 1994:978-984.

2. Resnick D, Niwayama G. Diagnosis of bone and joint disorders, 2nd ed. Philadelphia:Saunders, 1988:3623-3635.

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