Unusual presentation of osteoid osteoma mimicking osteomyelitis in a 27-month-old infant
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Published on: June 13, 2018
Ishwar Bhat1, Jeffrey Michael Zerin, David Adam Bloom
1Department of Pediatric Imaging, Children's Hospital of Michigan, Detroit, Michigan, USA. ibhat@dmc.org
Insights
Osteoid osteoma, a rare bone tumor in toddlers, can mimic chronic osteomyelitis. This case highlights unusual features that led to a confirmed diagnosis via biopsy.
Area of Science:
- Pediatric Orthopedics
- Skeletal Radiology
- Pediatric Pathology
Background:
- Osteoid osteoma is a rare, benign bone tumor typically affecting children and adolescents.
- It is exceptionally uncommon in children under three years old.
- Diagnosis can be challenging due to varied presentations.
Observation:
- A 27-month-old toddler presented with a limp and right knee swelling.
- Initial imaging (plain films, CT) suggested chronic osteomyelitis of the distal femur.
- Nuclear medicine bone scan showed findings typical of osteoid osteoma.
Findings:
- Histological examination of a biopsy confirmed osteoid osteoma.
- The case presented with atypical clinical and imaging features.
- This underscores the importance of considering rare diagnoses even with seemingly common presentations.
Implications:
- This case highlights the diagnostic challenges of osteoid osteoma in young children.
- It emphasizes the value of integrating multiple imaging modalities for accurate diagnosis.
- Early and accurate diagnosis is crucial for appropriate management and to avoid unnecessary treatments for conditions like osteomyelitis.
Abstract:
Osteoid osteoma is an uncommon, benign disorder of bone that is most often encountered in school-age children and in adolescents. It is quite rare in children under the age of 3 years. We report a case of osteoid osteoma with unusual clinical and imaging features in a 27-month-old toddler who presented with a limp and swelling of the right knee. Initial clinical evaluation, plain films, and computed tomography (CT) were strongly suggestive of chronic osteomyelitis involving the distal right femoral metadiaphysis. The appearance on nuclear medicine bone scan, however, was typical of osteoid osteoma. A biopsy of the lesion was taken and histological examination confirmed the diagnosis of osteoid osteoma. The misleading clinical and imaging features in this case are discussed.