Importance of Ruling Out Osteoid Osteoma in Hip Pain Syndrome

MASTAGLIA SR, AGUILAR G, OLIVERI B

Nashville, Tennessee,USA

Congreso; Twenty-Seventy Annual Meeting of the American Society for Bone and Mineral Research; 2005

The American Society for Bone and Mineral Research

Importance Of Ruling Out Osteoid Osteoma In Hip Pain Syndrome SR Mastaglia1*, G Aguilar2*, B Oliveri1 1Sección Osteopatías Médicas, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina, 2Servicio de Diagnóstico por Imágenes, Universidad de Buenos Aires, Buenos Aires, Argentina. Hip pain is a frequent presenting complaint in the clinical practice. Osteoid osteoma must be considered a likely diagnosis in young patients presenting chronic unspecific pain in this area. A 29 year –old Caucasian man was seen in the clinic offices due to pain in the right groin. Onset of pain was two years prior to consultation, and it increased with exercise. The patient had interrupted his usual sports practice (Rugby) due to progressively increasing pain. He had not traveled or been exposed to infectious disease. He had no antecedents of fever, trauma, or other musculoskeletal 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 healthy man. He reported tenderness in the groin and right upper thigh but no palpable mass or inguinal lymphadenopathy was found. Abduction and internal and external rotation of the right hip caused slight pain. A traumatologist who evaluated the patient two years previously indicated magnetic resonance imaging (MRI) of the right leg. Sequence T2 –weighting showed bone edema in the right femoral neck characterised by hyperintense signal 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 MRI showed persistence of cancellous bone edema without alteration in the femoral head despite time. Routine and mineral laboratory, bone densitometry and spine X-rays were normal. Pelvic radiography revealed slight bone sclerosis 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 presents reactive sclerosis and thickening. “Osteoid osteoma “ was diagnosed. Choice therapy is complete excision of the nidus. Osteoid osteoma is one of the most frequent and characteristic bone tumor lesions. The typical symptom is permanent pain, and symptom severity increases peaking at night. In the case of our patient, clinical presentation was 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 bone pain.