Osteoid osteoma of the hip: imaging features
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REVIEW ARTICLE
Osteoid osteoma of the hip: imaging features Jacques Malghem 1 & Frederic Lecouvet 1 & Thomas Kirchgesner 1 & Souad Acid 1 & Bruno Vande Berg 1 Received: 20 March 2020 / Revised: 8 June 2020 / Accepted: 9 June 2020 # The Author(s) 2020
Abstract Osteoid osteoma (OO), a small bone tumor relatively common in young subjects, frequently involves the hip. In addition to typical findings, we emphasize unsuspected clinical and imaging features including painless OO causing limping gait, nonvisibility of totally mineralized nidus, absence of hyperostosis or adjacent edema, and recurrence at distance from the initial location. We also discuss the option of medical treatment for some cases of deep hip locations. Keywords Osteoid osteoma . Hip . Imaging . Atypical presentations . Differential diagnosis . Recurrence
Introduction Osteoid osteoma (OO) accounts for 10 to 15% of all benign bone tumors. It mostly affects young subjects, mainly between 5 and 25 years with a male predominance [1–4]. Occurrence in older subjects is not unusual, with OO in 6 to 9% of subjects aged over 40 years in large series [1, 5]. An OO is a small, highly vascularized bone lesion that contains variable proportions of osteoid and woven bone surrounded by osteoblasts which form irregular trabeculae interspersed with osteoclasts and numerous dilated vessels [1]. The tumor itself, the nidus, does not invade adjacent bone, but it induces hyperostosis and bone marrow edema [1, 2]. The presence of nerve fibers can be demonstrated by special stains close to the blood vessels around the nidus and in some cases within the nidus [6, 7]. The majority of OOs arise in the cortex of long bones, where the lesion is usually diaphyseal or metadiaphyseal. Epiphyseal OOs are rare [2]. About 10% of OOs are intraarticular, of which nearly half occurs in the hip [8]. The most common location in the hip is the femoral neck. This area is intra-articular as it is surrounded by the synovial cavity and joint capsule [2]. This intra-articular location results in atypical clinical signs and unusual characteristics on imaging [8–11].
* Jacques Malghem [email protected] 1
Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate, 10, B-1200 Brussels, Belgium
We summarize common clinical and imaging features observed in patients with OO and we focus on less common features observed especially in hip location.
Clinical symptoms Almost invariably, patients with OO have pain. Pain is initially mild and inconstant, and may become more severe and persistent. Typically, the pain is more intense at night [2, 3, 12]. Pain relief can be obtained with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) in nearly three-quarters of the cases [2, 12]. The pain is thought to be caused by increased pressure stimulating nerve fibers, linked to an abnormally high prostaglandin concentrations in the lesion (up to 30 times higher or more) [13]. This hypothesis explains the effectiveness of aspirin and NSAIDs, which both inhibit pr
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