Intra-Articular Osteoid Osteoma: Radiological Manifestations

Abstract

A 9-year-old boy presented to the rheumatology consultation with left elbow pain for the prior three months. The pain was associated with swelling, stiffness, and limitation of movement suggestive of inflammation. The blood work was normal. Mono-articular juvenile idiopathic arthritis (JIA) was suspected, and the patient was referred for left elbow ultrasound, which confirmed synovial thickening (arrow on Figure 1A). Treatment with nonsteroidal anti-inflammatory drugs was started, and three weeks later an intra-articular infiltration with cortico-steroids was carried out. Three months later, as the symptoms persisted, a new ultrasound of the elbow was performed, demonstrating joint effusion (asterisk on Figure 1B); elbow radiograph on the same day showed metaphyseal sclerosis (blue asterisk on Figure 2A), peri-articular osteopenia (green asterisk on Figure 2A) and periosteal apposition (arrows

Multimodality Imaging of a Patient with Intra-Articular Osteoid Osteoma: A Case Report

“…Accurate diagnosis of intra-articular osteoid osteoma may be delayed because the lesion often does not show the typical clinical and imaging features of osteoid osteoma. 2,5,6 Intra-articular osteoid osteomas occur within or near the joints [5][6][7] and most commonly affect the hip joint, but have also been reported in the ankle, the elbow, the knee and the wrist. 2,6,7 Clinically, this tumor manifests itself in nonspecific joint-related symptoms, such as pain, swelling, joint effusion, and limited range of motion.…”

“…2,5,6 Intra-articular osteoid osteomas occur within or near the joints [5][6][7] and most commonly affect the hip joint, but have also been reported in the ankle, the elbow, the knee and the wrist. 2,6,7 Clinically, this tumor manifests itself in nonspecific joint-related symptoms, such as pain, swelling, joint effusion, and limited range of motion. 2,6,7 These clinical findings, also seen in patients with different forms of inflammatory arthritis, can lead to diagnostic errors and delayed diagnosis.…”

“…2,6,7 Clinically, this tumor manifests itself in nonspecific joint-related symptoms, such as pain, swelling, joint effusion, and limited range of motion. 2,6,7 These clinical findings, also seen in patients with different forms of inflammatory arthritis, can lead to diagnostic errors and delayed diagnosis. [5][6][7] Patients with intra-articular osteoid osteomas less commonly describe the characteristic for extra-articular osteoid osteoma pain that worsens at night and is relieved by NSAIDs.…”

“…2,6,7 These clinical findings, also seen in patients with different forms of inflammatory arthritis, can lead to diagnostic errors and delayed diagnosis. [5][6][7] Patients with intra-articular osteoid osteomas less commonly describe the characteristic for extra-articular osteoid osteoma pain that worsens at night and is relieved by NSAIDs. 2,5,6 On imaging, intra-articular osteoid osteoma typically shows a lesser degree of or no cortical thickening and reactive sclerosis, and thus deviates from the imaging appearance of the extra-articular forms of the tumor.…”