CT-guided percutaneous cryoablation of an osteoid osteoma of
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An osteoid osteoma (OO) is a benign bone tumor that arises from osteoblastic dysfunction and usually presents as nonspecific, nocturnal pain located in the diaphysis of long bones, with <1% occurring in the ribs.

It is most commonly treated with nonsteroidal anti-inflammatory drugs or merely observed; when these treatments do no prove efficacious, either open surgery or interventional ablation are pursued.

Published in the journal Radiology Case Reports, the authors report a rare case of an osteoid osteoma located in the rib of a 19-year-old male that was histologically diagnosed through computed tomography (CT)-guided biopsy.

A 19-year-old male presented to his primary care physician with 8 months of constant, predominantly aching, right lateral chest wall pain that was most severe at night and relieved with NSAIDs. He denied a history of trauma, shortness of breath, cardiac symptoms, or sternal pain. An initial chest x-ray was normal, but after 2 months of unresolved symptoms a CT scan was performed revealing a 7 mm, well-circumscribed, cortical lucency at the lateral seventh rib.

The lesion contained an intracortical calcified nidus, and was surrounded by sclerosis, raising the possibility of an OO. The patient subsequently was prompted to visit a thoracic surgeon who then referred the patient to our interventional radiology clinic.

Based on the above clinical scenario and CT appearance a likely diagnosis of OO was established, and the patient was scheduled for a CT-guided biopsy and cryoablation under general anesthesia.

Using CT guidance, the tumor was ablated by creating an artificial pneumothorax in order to induce a margin of space safe enough for cryoablation.

Key takeaways:-
- It is important to be aware of the possibility that an osteoid osteoma may be present in the ribs, as the differential diagnosis includes costochondritis, pneumonia, osteoblastoma, enchondroma, osteosarcoma, cyst, and Brodie abscess.

- CT-guided cryoablation can be an effective and less invasive treatment when compared to open en bloc resection, highlighting the role of interventional radiology in bone tumor ablation.

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