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CT guided biopsy
9%
246/2708
CT of chest , abdomen, and pelvis
5%
141/2708
CT guided radiofrequency ablation
78%
2110/2708
En bloc surgical resection resection
1%
38/2708
Open surgical curettage with chemical cauterization and cementing
6%
160/2708
Select Answer to see Preferred Response
The clinical and radiograhic presentation are consistent with osteoid osteoma. The first line of treatment, which should include observation and NSAID administration, has failed so the next step in treatment should be CT guided radiofrequency ablation. Volkmer et al discusses the use of radiofrequency ablation and state indications for radiofrequency ablation of osteoid osteomas are when medical management fails, the lesion is leading to a scoliotic deformity, or the lesion is periarticular placing the patient at increased risk of cartilage injury and premature degenerative disease. Moser et al present a therapeutic case series (level IV evidence) that shows an overall clinical success rate of 98% (of 68 patients) when using image-guided laser ablation to treat osteoid osteomas in pediatric patients. The final reference by Lee et al is a review article of osteoid osteomas. Incorrect Answers: Answer 1: A CT guided biopsy alone is not indicated as the clinical and radiographic presentation are diagnostic and it is not worth the added risks of an additional procedure. Answer 2: Based on imaging studies alone we can establish the diagnosis, and therefore a workup for a malignant process is not required. Answer 4 & 5: The osteoid osteoma in this case does not meet any surgical indications.
3.6
(23)
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