80_eposter - Stanley Radiology

Osteoid osteoma is a common entity with male
predilection, male to female ratio – 4:1
Most of the effected are young individuals in second
decade of life.
Dull aching deep bone pain - worsening in the nights,
relieved by analgesics.
On physical examination tenderness is present.
Signs of inflammation including erythema, warmth are
almost always absent
 The
treatment options available are Surgery and
Radio Frequency Ablation.
 Due
to the prolonged hospital stay, complications
and incomplete removal of the nidus leading to
recurrence; surgery is a less desired option.
 Radio
Frequency Ablation has proved to be
quick, safe and minimally invasive method of
A 17 year old Indian male patient complaints of 8
months deep bone pain over left hip.
Pain was worsening at night with sleep disturbance,
aggravated on walking and relieved on rest.
H/o trauma 2 years back- slip and fall from height of
10 meters.
No H/o recent fever. No H/o pain over small joints or
early morning stiffness.
N/K/C/O DM/BA/TB/Jaundice
 Scarpa triangle tenderness present.
 Muscle wasting was evident
over the thigh and calf regions.  Greater trochanter tenderness present.
 Scarpa triangle fullness is seen  No mass palpable.
in the left hip.
 Left anterior superior iliac
spine is inferior compared to
right side(pelvic tilt)
 No limb length discrepancy or
gluteal muscle wasting
 Flexion and internal rotation
movements of left hip joint were
 Trendenlenburg test: Positive
 Femoral and distal pulses felt.
 Active toe movements present.
 Sensation intact.
 The
patient was then admitted and all the
baseline investigations were done.
 All
the baseline investigations were found to
be within normal limits.
 The
patient was then subjected for
Radiological investigations.
Image A : (Shows)
 Oval lytic lesion (nidus) at
the medial cortex of the left
femoral neck near the lesser
trochanter with surrounding
sclerosis and adjacent
cortical thickening.
 Nidus measured 2.0 x 1.2 cm
(Cc x Tr) with internal
calcific foci.
Image A
Oval lytic lesion (nidus) 2.0 x 1.2 cm at the medial cortex of the left femoral neck near the
lesser trochanter with surrounding sclerosis and adjacent cortical thickening.
 Radio
Frequency Ablation was planned after
radiological confirmation of the diagnosis of
Osteoid osteoma.
 Prothrombin
time and international normalized
ratio (INR) were tested and found within normal
 Anaesthetist’s
 Prophylactic
evaluation was carried out.
antibiotic (Cefotaxime 1 gm ) was
administered immediately before the procedure.
Lesion localization done with 128 multi detector row CT to confirm accurate needle position within the nidus.
 (Image on the (L): Scout image confirming the needle position with gonadal pads
 Image (R)Red arrow – Bone biopsy cannula. Yellow arrow – tip of the electrode)
 Under CT guidance and spinal anaesthesia, percutaneous entry into the osteoma nidus was made using
osteocyte bone biopsy cannula (13 G) with a drill and Kirchner wire.
Aspiration of the nidus content was done and sent for
histo pathological examination – diagnosis of osteoid
osteoma was confirmed.
Nidus was ablated in two locations(cranial and caudal)
by two bone tracts. Calories ablated were 1.27 Kcal
and 1.6 Kcal respectively for 5 minutes each.
Injection lignocaine 2 ml was injected into the nidus at
the end of the procedure.
The duration of the procedure was 120 minutes.
Image above shows needle tracts taken during Radio
Frequency Ablation(coronal).
Above images show needle tracts in various sections
The image above is a post procedural x ray showing
needle tracts.
The patient reported to have immense pain relief without any
analgesics the very next day.
Complaining of pain only at skin entry site.
Normal sleep in the night.
Patient was advised to avoid vigorous activities, sports such as
jumping long distance running for a month.
This was the first Radio frequency Ablation procedure done in
the Pondicherry territory.
 A follow
up X ray of pelvis was done after 30
days – needle tracts were evident.
 No
fresh complaints from the patient.
 Bone
 No
pain relieved.
other delayed complications were reported.
 The
post procedural period was uneventful
 An
Osteoid osteoma is a benign skeletal tumour
usually less than 1.5 cm in diameter.
 Composed
of woven bone and an osteoid and
more located in the appendicular bone.
 Focal
 Pain
pain at the tumour site.
worsens in the night and increases with
activity and is relieved with analgesics and
inflammatory medications.
 The
pain is presumed to be a result of local
vasodilatation resulting from elevated levels
of PGE2 at the site of the tumour.
 Spinal
osteoid osteoma may in addition lead to
 These
tumours usually regress spontaneously ,
the mechanism probably being bone
Difficulty in lesion localization, consequences of
extensive dissection and need for prolonged
recuperation and risk of incomplete removal and
therefore recurrence of the lesion make surgery a less
desired option.
Radio Frequency Ablation is proved to be safe, quick
and minimally invasive method of management.
We were able to achieve a high technical and clinical
success without any complications. Percutaneous
Radio Frequency Ablation should be the method of
choice for treating extra spinal osteoid osteoma.
Cartnell CP,O Byrne J , Eusrac 3 Radio frequency ablation of osteoid
osteoma with cooled probes and impedance control energy delivery, AJR
AM J Roentgenol 2006; 186 (5 suppl) S 244- S248 (cross ref J E
Rosanthal DI, Marota JJA, Hornicok FJ osteoid osteoma :elevation of
respiratory and cardiac rates at the biopsy needle entry into the tumour in
10 patients, Radiology 2003,226: 125-128 (abstract medicine)
Resnik D, Kyariakos M, Guerdn D, Greenway bone and joint imaging, 3rd
ed, Elsevier Saunders;2005 Tumours and tumour like lesions of
bone:Imaging pathology of specific lesions;pp1121-98
Kitsoulis P , Mantellos G, Vlychou M, Osateoid osteoma,Acta Orthop
Belg.2006;72 119-25 (PubMed)
Solav SV, lack of hypervascularity on three phase bone scan:osteoid
osteoma revisited.World J Nucl Med. 2006;5:1

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