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Osteoid Osteoma in the Finger

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0:01

Here, we have yet another case of an osteoid

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osteoma, and I hope this convinces you that

0:06

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,

0:21

and the image on your right is a plain radiograph,

0:23

and in the center we have the—this is supposed

0:27

to be a fat-suppressed fluid-sensitive

0:29

sequence, but as you can imagine, as you can

0:31

see, there wasn't a lot of great fat

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suppression that has happened, but not to mind.

0:36

The diagnosis can actually be made

0:37

very, very well on the plain radiograph.

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All we can tell from the frontal radiograph

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is that there is intense, mature periosteal

0:46

reaction around this bone, which is the

0:49

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

0:56

by an area of increased sclerosis.

0:59

That's difficult to appreciate

1:00

on a frontal projection.

1:01

However, if you go to the lateral

1:03

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

1:11

like what we saw in the prior vignette.

1:13

where we looked at osteoid

1:14

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.

1:40

Look at that intense,

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mature periosteal reaction.

1:44

Oftentimes these are treated with

1:46

NSAIDs, but frequently, for the pain

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to be relieved, they have to be treated

1:51

with radiofrequency ablation or surgery.

1:54

If you want to look at further evidence for

1:56

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.

2:07

Another great example of an osteoid osteoma.

2:10

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

2:18

like a duck, it probably is a duck.

2:20

So this is a duck.

Report

Faculty

Mahesh Thapa, MD, MEd, FAAP

Division Chief of Musculoskeletal Imaging, and Director of Diagnostic Imaging Professor

Seattle Children's & University of Washington

Tags

X-Ray (Plain Films)

Pediatrics

Non-infectious Inflammatory

Musculoskeletal (MSK)

MRI

Idiopathic

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