MedPix Medical Image Database

COW - Case of the WeekCase Contributor: Omar KhanAffiliation: Childrens Hospital of Dayton, OH

MedPix No: 14410 - HistoryPt Demographics: Age = 15 y.o. Gender = boyPatient is a 15 year old Caucasian male who presented with several months of unrelenting back pain along with the development of scoliosis. Pain is reported to be worse during nighttime and no longer controlled with the use of NSAIDs.

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MedPix No: 14410 - EXAM & LABSPhysical exam is remarkable only for S shaped scoliosis (right thoracic curve and left lumbar curve).No abnormal laboratory findings.

Osteoid Osteoma

Standing AP radiograph of thoracolumbar spine depicting thoracolumbar levoscoliosis with the apex at approximately T11.

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Osteoid Osteoma

MRI depicting mildly enhancing mass at the lamina of T11 on the right side which measures 2.7 x 1.3 x 2.0 cm. Corresponds to the apex of the levoscoliosis. Edema present in right erector spinae musculature.

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Osteoid Osteoma

MRI depicting mildly enhancing mass at the lamina of T11 on the right side which measures 2.7 x 1.3 x 2.0 cm. Corresponds to the apex of the levoscoliosis. Edema present in right erector spinae musculature.

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Osteoid Osteoma

MRI depicting mildly enhancing mass at the lamina of T11 on the right side which measures 2.7 x 1.3 x 2.0 cm. Corresponds to the apex of the levoscoliosis. Edema present in right erector spinae musculature.

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Osteoid Osteoma

MRI depicting mildly enhancing mass at the lamina of T11 on the right side which measures 2.7 x 1.3 x 2.0 cm. Corresponds to the apex of the levoscoliosis. Edema present in right erector spinae musculature.

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Osteoid Osteoma

MRI depicting mildly enhancing mass at the lamina of T11 on the right side which measures 2.7 x 1.3 x 2.0 cm. Corresponds to the apex of the levoscoliosis. Edema present in right erector spinae musculature.

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Osteoid Osteoma

CT of thoracic spine depicting area of abnormality at T11 vertebral body just medial to the inferior costal - facet. There is a well-defined 1 cm lytic lesion with a bony nidus which demonstrates a large amount of benign appearing sclerotic bony overgrowth in the surrounding bone.

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FINDINGSStanding AP and lateral thoracolumbar spine:S-shaped thoracolumbar scoliosis. 16 degrees dextroscoliosis between T2 and T8.33 degree levoscoliosis between T9 and L2. 19 degreedextroscoliosis between L3 and L5MRI of the thoracic spine: Mildly enhancing mass at the lamina of T11 on the right side which measures 2.7 x 1.3 x 2.0 cm. Likely originating in the soft tissue anderoding into the pedicle. Corresponds to the apex of thelevoscoliosis. Edema present in right erector spinae musculature.CT of the thoracic spine:Area of abnormality on the MR is along thelamina of the T11 vertebral body just medial to the inferior costal facet. There is a well-defined 1 cm lytic lesion with a bony nidus which demonstrates a large amount of benign appearing sclerotic bonyovergrowth in the surrounding bone.

DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis? Osteoid Osteoma- - Osteoblastoma- - Solid Aneurysmal Bone Cyst

Diagnosis: Osteoid OsteomaDx Confirmed by: CT, MRI, and histologic examination

DISCUSSION