Importance of running out osteoid osteoma in hip pain syndrome

MASTAGLIA SR; AGUILAR G; OLIVERI B

Nashville,USA

Congreso; 27th Meeting American Society Bone and Mineral Research; 2005

ASBMR

Importance of Ruling Out Osteoid Osteoma in Hip Pain Syndrome  Mastaglia SR, Aguilar G, Oliveri B Resumen: Importance Of Ruling Out Osteoid Osteoma In Hip Pain Syndrome SR Mastaglia1*, G Aguilar2*, B Oliveri11SecciónOsteopatías Médicas, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina, 2Servicio deDiagnóstico por Imágenes, Universidad de Buenos Aires, Buenos Aires, Argentina. Hip pain is a frequentpresenting complaint in the clinical practice. Osteoid osteoma must be considered a likely diagnosis in youngpatients presenting chronic unspecific pain in this area. A 29 year old Caucasian man was seen in the clinicoffices due to pain in the right groin. Onset of pain was two years prior to consultation, and it increased withexercise. The patient had interrupted his usual sports practice (Rugby) due to progressively increasing pain. Hehad not traveled or been exposed to infectious disease. He had no antecedents of fever, trauma, or othermusculoskeletal pain. The pain was dull and aching, was not associated with any specific activity or time of day,and decreased with anti-inflammatory drugs (AINES). On physical examination, he appeared to be a healthyman. He reported tenderness in the groin and right upper thigh but no palpable mass or inguinallymphadenopathy was found. Abduction and internal and external rotation of the right hip caused slight pain. Atraumatologist who evaluated the patient two years previously indicated magnetic resonance imaging (MRI) of theright leg. Sequence T2 weighting showed bone edema in the right femoral neck characterised by hyperintensesignal in cancellous bone, without alteration in the femoral head. Diagnosis at the time was transient osteoporosis. Avascular necrosis of the hip was ruled out. Further MRI studies were performed for follow-up. The second MRIshowed persistence of cancellous bone edema without alteration in the femoral head despite time. Routine andmineral laboratory, bone densitometry and spine X-rays were normal. Pelvic radiography revealed slight bonesclerosis with thickening of the medial cortex at the level of the right femoral neck. The Computed Tomography scan revealed a lucent lesion (nidus) in close contact with the medial cortex of the femoral neck, which presentsreactive sclerosis and thickening. Osteoid osteoma was diagnosed. Choice therapy is complete excision of thenidus. Osteoid osteoma is one of the most frequent and characteristic bone tumor lesions. The typical symptom ispermanent pain, and symptom severity increases peaking at night. In the case of our patient, clinical presentationwas not typical and diagnosis was possible because the physician strongly suspected it to be osteoid osteoma.Thus, image diagnosis studies other than x-rays must be performed, allowing correct diagnosis of Osteoid Osteoma in a young person presenting a bone pain