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Osteoid Osteoma - Tibia

Case Detail

Anatomy: Musculoskeletal
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: MR
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15 year old female with 3 month history of mid-leg pain.

Case Images


Osteoid Osteoma – Tibia


MR – Sagittal IR and axial fat-suppressed T2 and postgadolinium T1 images show segmental marrow edema, periosteal edema, cortical hyperostosis and a round T2 and post-gadolinium hyperintense nidus.


Osteoid osteoma (OO)is a common benign tumor, most commonly seen in adolescent caucasian boys. OO may develop in any bone but are most common in the femoral neck, followed by the tibia; the upper extremities are infrequently involved although there is a preponderance for the tubular bones of the hands. The metaphysis and metadiaphysis are the most common portions of the bone involved followed by the diaphysis and rarely the epiphysis. Flat bone are uncommonly involved but the posterior vertebral arch involvement can cause painful scoliosis.

The classic symptoms of OO are focal pain, worse at night, alleviated by non-steroidal anti-inflammatory agents. The nidus of the lesion is variably ossified; the nidus may be non-ossified, peripherally ossified or densely ossified. Cortical OO are usually surrounded by a band of dense bone. Intra-articular OO are associated with joint effusion but little or no surrounding sclerosis. Subperiosteal OO often erode the cortex. The nidus usually measures up to 15 mm in diameter and is better seen on CT than radiography or MR.

The differential diagnosis included osteomyelitis and healing stress fracture; the history and lack of abnormal inflammatory markers help suggest the correct diagnosis. OO can be treated by surgical excision or ablation (radiofrequency or cryoablation) of the nidus.


Kaste SC, Strouse PJ, Fletcher BD, Neel MD. Benign and Malignant Bone Tumors. Caffey’s Pediatric Diagnostic Imaging, 11th Ed. Mosby-Elsevier (2008).

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