I had a CT scan for pelvic pain. What does the film indicate?

Hello,

Welcome to icliniq.com.

I understand your concern.

Thanks for writing to us, and I have gone through the CT scan images (attachment removed to protect patient identity).

There is a lesion in the right intertrochanteric area that is showing characteristics of an osteoma, which is almost always a benign condition. One must look out for any severe pain and any abnormal bone growth in the area. Many osteomas might disappear with time, and no active treatment is needed. In cases when the pain is severe, then surgery and bone curettage might help.

There is a likely area of excess calcium deposition showing a white spot in the left iliac bone near the left sacroiliac joint area, and it is called a bone island. A bone island is usually not treated. However, to confirm a bone island and to rule out other lesions, a nuclear bone scan can help. The thickening of the left anterior pararenal fascia is likely not significant. The gall bladder is not well visualized.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

By definition, an osteoma is usually smaller than 0.7 inches in size. In your case, the lesion in the intertrochanteric area of the right femur measures 15 mm and fits the definition of an osteoma. Osteoid osteomas are more common in a younger age group, from 10 to 35 years. A central sclerotic dot is seen in many lesions, but not in all lesions.

However, the other differential diagnoses can include LSMFT (liposclerosing myxofibrous tumors), keeping in mind the location and lucent center with sclerotic margins, and it is slightly more common in males aged 30 to 40 years.

Both conditions can cause vague pain and discomfort in the area of the lesion.

Treatment options in both cases are confirmation by biopsy and surveillance. Surgery is a thought only in cases of suspected aggressive activity in the lesion.

In view of the size and the lesion being minimally expansile and a smaller lucent component, I would prefer to go for an osteoid osteoma as the first diagnosis and keep LSMFT as the second diagnosis.

Other less likely differentials for this condition might include fibrous dysplasia, non-ossifying fibroma, polymorphic fibro-osseous tumor of bone, myxofibroma, lipoma, cyst, bone infarct, Paget's disease, and chondroma.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.

Hi,

Welcome back to icliniq.com.

1. The lesion in the neck of the right femur does not show up on the bone scan and, therefore, is likely confirmed as a benign etiology and does not show any cell activity. A nuclear scan does not specify the exact cause

2. There is moderate uptake in the lower end of the right radius, which can mean that some activity is taking place at the cell level. The results of the bone scan are non-specific and therefore, an X-ray followed by a higher diagnostic radiology imaging like a CT (computerized tomography) scan or an MRI(magnetic resonance imaging) scan might be needed to know in detail about the area.

3. Mild uptake in the medial part of the left iliac bone can be due to the previously mentioned and suspected bone island.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

Going by basics, osteooid osteoma almost always shows uptake on bone scan, but LSMFT can show mild uptake on bone scan in some cases. Therefore, I would choose LSMFT as the first possibility over osteoid osteoma. In most cases, treatment is towards pain relief as long as the lesion is not significantly growing on follow-up scans. If pain is severe, then surgery can help. If the pain is tolerable, then please try medicines for 6 to 12 months and then follow up as needed to look for an increase in the lesion. At any time, if the pain gets severe, then a surgical treatment might be indicated.

The thoracic cage is the rib area, and the distal shaft of the left radius is the wrist area. I am not sure if you have had any old injury in the areas or any sort of discomfort or pain due to any low-intensity trauma, such as sports activity. The exact area of activity in the ribs is clearly not mentioned. However, the distal left radius is a bone in the thumb side of the left forearm and wrist area, in simple language.

To me, it looks like a bone island as the activity is mentioned as mild. In a cancerous condition, the activity is significant. However, follow-up imaging of the area may be done in a year, when checking out the femur lesion.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

After viewing the MRI images, there is a sclerotic rim with a relatively isointense central area on T1 and hyperintense on T2 STIR images, and no significant bone edema in the right neck of femur lesion. The lesion is not aggressive in nature. Features are more like an LSMFT. Osteoid osteoma is less likely, but cannot be completely ruled out, as you know. The lesion in the left iliac blade is most likely a bone island.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

1. I feel the chances of a bone island are almost certain in the left iliac bone area.

2. I shall think of LSMFT due to the imaging characteristics and typical location, and NOF is also among the list of lesions due to the features of a high signal surrounded by low signal. Osteoid osteoma is unlikely, and I will put it lower down in the list.

3. There is an alarm only if we see a T2 hypointense lesion in the peripheral zone of the prostate. An inhomogeneity in the area is not of concern.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.