CASE 12164 Published on 01.10.2014
0

Osteoma osteoid of capitate

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

Ferreira I, Oliveira J, Certo M, Cardoso P

Centro Hospitalar do Porto,
Radiology;
Largo Professor Abel Salazar 4
099-001 Porto, Portugal;
Email:ivo.ricardo@gmail.com
Connected authors
Ivo Ferreira PORTUGAL
Patient

34 years, male

Categories
Area of Interest Musculoskeletal bone ; Imaging Technique MR, CT, Nuclear medicine conventional
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Clinical History
A 34-year-old-man presented with a four-year history of wrist pain, managed unsuccessfully with radial styloidectomy and steroid injections. Trauma or other potential health issues were excluded as pain triggers.
Imaging Findings
MR images reveal marked capitate oedema (Fig. 1). A small hypointense lesion in T1 and T2 weighed images is seen in the proximal pole of this bone, associated with the presence of a calcified component (Fig. 2, 3).
Subsequent CT revealed a lucent nidus with a thin surrounding sclerotic reactive bone. A central sclerotic dot is also visible (Fig. 4).
Bone scintigraphy shows focal intense uptake of radioisotope at the corresponding site of the lesion seen on MR and CT images (Fig. 5).
Discussion
Osteoid osteomas are benign tumours that are more frequently found in young patients. The main symptom is local pain, which typically aggravates at night and is relieved by salicylates. [1]
Osteoid osteomas are twice as frequent in men. [2, 3]
They are more prevalent in long bones, but can also affect other bones such as the spine, the small bones of the hand and feet, and even the skull. [2, 3] The incidence of osteoid osteomas in the hands is estimated as 8%, being more frequent in phalanges, followed by carpal bones, and less frequently found in metacarpal bones. [9]
Osteoid osteomas can be depicted by plain radiograph, but CT has the best diagnostic accuracy, even when compared with MR. [4, 5] Typically it shows a lucent nidus with surrounding sclerotic bone and a central sclerotic dot.
Bone scintigraphy has a high sensitivity, but is not specific, whereas the nidus might not be seen on MR. [6]
The size of the lesion is very important to differentiate osteoid osteomas from osteoblastomas, since the last ones are much larger (>2cm). [10]
It has been suggested that the natural history of osteoid osteomas is spontaneous healing, with pain resolution after 6 to 15 years. [7]
CT-guided procedures, particularly radiofrequency have modified the treatment of osteoid osteoma, with superior outcomes. [8]
This is the treatment option for our patient, although it hasn't been done yet, because the patient was recently diagnosed with a brain tumour which will be treated first.
Differential Diagnosis List
Osteoid osteoma of capitate
Osteoid osteoma
Osteoblastoma
Final Diagnosis
Osteoid osteoma of capitate
Case information
URL: https://www.eurorad.org/case/12164
DOI: 10.1594/EURORAD/CASE.12164
ISSN: 1563-4086
Figure 1

PD weighted image

PD weighted image
PD weighted image with fat suppression in the coronal plane. There is an important oedema of the capitate (yellow arrows), while the other bones have normal signal.
Figure 2

T1 weighted image

T1 weighted image
T1 weighted image in the axial plan, showing a small hypointense lesion (orange arrow) in the palmar face of capitate.
Figure 3

T2 weighted image

T2 weighted image
T2 weighted image in the coronal plane showing a hypointense small rounded lesion in the proximal pole of capitate (green arrow).
Figure 4

CT image

CT image
CT image in the axial plane and in bone window, demonstrating the sclerotic border of the lesion, with a lucent nidus and a central scleroric dot (red arrow).
Figure 5

Bone scintigraphy

Bone scintigraphy
Bone scintigraphy shows focal intense uptake of radioisotope in the right capitate (blue arrows).