0:01

Here, we have yet another case of an osteoid

0:03

osteoma, and I hope this convinces you that

0:06

this is an inflammatory process that creates a

0:10

lot of inflammation in the adjacent bone, and

0:15

it typically is located at the very periphery.

0:18

The image on your left is a plain radiograph,

0:21

and the image on your right is a plain radiograph,

0:23

and in the center we have the—this is supposed

0:27

to be a fat-suppressed fluid-sensitive

0:29

sequence, but as you can imagine, as you can

0:31

see, there wasn't a lot of great fat

0:33

suppression that has happened, but not to mind.

0:36

The diagnosis can actually be made

0:37

very, very well on the plain radiograph.

0:40

All we can tell from the frontal radiograph

0:42

is that there is intense, mature periosteal

0:46

reaction around this bone, which is the

0:49

proximal phalanx of the ring finger.

0:52

You may notice that there's a little

0:54

subtle lucency right over here, surrounded

0:56

by an area of increased sclerosis.

0:59

That's difficult to appreciate

1:00

on a frontal projection.

1:01

However, if you go to the lateral

1:03

view, you can see that there is this

1:06

central area of brightness and this

1:08

peripheral area here of lucency, much

1:11

like what we saw in the prior vignette.

1:13

where we looked at osteoid

1:14

osteoma involving the cuboid bone.

1:17

Again, notice how peripheral it's located,

1:20

giving credence to the idea that this

1:22

is a subperiosteal or cortical process.

1:25

And maybe sometimes when we see it very

1:27

mature, the fact that it's present more

1:29

centrally in the bone means that all this

1:32

additional bone has grown around it and

1:34

has remodeled, but it really did start out

1:37

in the periosteum or subperiosteal tissue.

1:40

Look at that intense,

1:42

mature periosteal reaction.

1:44

Oftentimes these are treated with

1:46

NSAIDs, but frequently, for the pain

1:49

to be relieved, they have to be treated

1:51

with radiofrequency ablation or surgery.

1:54

If you want to look at further evidence for

1:56

inflammation, look at the soft tissues at the

1:58

very dorsal or posterior aspect of that digit.

2:01

It's really, really swollen versus the normal

2:04

thickness of the soft tissue more distally.

2:07

Another great example of an osteoid osteoma.

2:10

In a relatively uncommon location,

2:13

especially in the pediatric population.

2:15

But, if it walks like a duck, and quacks

2:18

like a duck, it probably is a duck.

2:20

So this is a duck.