Interactive Transcript
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Here, we have yet another case of an osteoid
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osteoma, and I hope this convinces you that
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this is an inflammatory process that creates a
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lot of inflammation in the adjacent bone, and
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it typically is located at the very periphery.
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The image on your left is a plain radiograph,
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and the image on your right is a plain radiograph,
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and in the center we have the—this is supposed
0:27
to be a fat-suppressed fluid-sensitive
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sequence, but as you can imagine, as you can
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see, there wasn't a lot of great fat
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suppression that has happened, but not to mind.
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The diagnosis can actually be made
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very, very well on the plain radiograph.
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All we can tell from the frontal radiograph
0:42
is that there is intense, mature periosteal
0:46
reaction around this bone, which is the
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proximal phalanx of the ring finger.
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You may notice that there's a little
0:54
subtle lucency right over here, surrounded
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by an area of increased sclerosis.
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That's difficult to appreciate
1:00
on a frontal projection.
1:01
However, if you go to the lateral
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view, you can see that there is this
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central area of brightness and this
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peripheral area here of lucency, much
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like what we saw in the prior vignette.
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where we looked at osteoid
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osteoma involving the cuboid bone.
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Again, notice how peripheral it's located,
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giving credence to the idea that this
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is a subperiosteal or cortical process.
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And maybe sometimes when we see it very
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mature, the fact that it's present more
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centrally in the bone means that all this
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additional bone has grown around it and
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has remodeled, but it really did start out
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in the periosteum or subperiosteal tissue.
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Look at that intense,
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mature periosteal reaction.
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Oftentimes these are treated with
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NSAIDs, but frequently, for the pain
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to be relieved, they have to be treated
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with radiofrequency ablation or surgery.
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If you want to look at further evidence for
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inflammation, look at the soft tissues at the
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very dorsal or posterior aspect of that digit.
2:01
It's really, really swollen versus the normal
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thickness of the soft tissue more distally.
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Another great example of an osteoid osteoma.
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In a relatively uncommon location,
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especially in the pediatric population.
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But, if it walks like a duck, and quacks
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like a duck, it probably is a duck.
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So this is a duck.
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