A Young Woman with Right Hip Pain

MARCH 13, 2014
James D. Collins, MD

James D. Collins, MD

This 24-year-old woman presented with the complaint of right hip pain that she has had for 2 years. She described the pain as deep and persistent, radiating to her right buttocks and anterior thigh, and increasing in severity at night, though its distribution was nonsciatic. Although muscle rubs and heat did not relieve the pain, it resolved completely with aspirin administration.

The patient continually increased the dosage and at presentation, she was taking 600 mg of aspirin every 3-4 hours. Her physical examination findings were essentially negative, save for the aching and tender right hip.
 
Radiographic Findings

The woman’s anterior-posterior (AP) pelvis radiograph (Figure 1) displayed a small, round, radiolucent lesion marginated by an area of increased bone density in the cortical margin of the right femur adjacent to the lesser trochanter.


Figure 1 This AP radiograph displays the characteristic small, round, radiolucent lesion of osteoid osteoma (arrows) marginated by an area of increased bone density within the cortical margin of the femur. F=femur.

An AP radiograph of her right femur (Figure 2) displayed the same findings, while an enlarged AP view (Figure 3) provided greater detail of the central lucency and marginal sclerosis. A technetium-99m (Tc-99m) bone scan (not illustrated) was positive with intense scintigraphic activity in the central nidus and less intense activity in the area of peripheral sclerosis.


Figure 2 This AP view displays the right femur with the radiolucent nidus (bar arrow) surrounded by increased bone density within the cortical margin of the femur (arrows).


Figure 3 This enlarged AP view clearly defines the central lucency of the lesion (bar arrow) and marginal sclerosis (small arrows).



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