Radiological Imaging Findings of a Case with Vertebral Osteoid Osteoma Leading to Brachial Neuralgia
An 18-year-old male patient presented with a 6-month history of pain in the neck, shoulder, and left arm. The pain had increased over 6 months and become more evident during the night. He had no infection or history of trauma. He had been treated with salicylates and other painkillers that reduced his complaints. On physical examination, hypoesthesia was found on his C7-T1 dermatomas and no pathological finding was evident in the laboratory evaluation.\nOn anteroposterior cervical X-ray of the patient, a well-contoured radiolucent nodular lesion, 1.5 cm in diameter, which had a thin highly sclerotic rim around was evident on T1 vertebra left lamina-transverse process junction. In addition, minimal scoliosis whose opening was toward left was noticed on cervical vertebral axis []. Upon finding the brachial neuralgia and nodular lithic lesion on the bone, contrast-enhanced MRI examination was performed to determine the possible association of lesion with brachial plexus elements and neighboring tissues as well as to rule out other causes of brachial neuralgia such as disc lesions. On MRI of the patient, about 1.5 cm diameter bone lesion of slightly expansile nature located on T1 vertebra left transverse process-lamina junction was observed. There was a rim around the lesion, which was well-contoured and had focus areas void of signal on all MRI series, suggesting millimetric calcification and hypointense sclerosis. There were hypointense signals on T1-weighted series and slightly hypointense signals on T2-weighted series, concordant with intense edema in the paravertebral soft tissues and in the bone marrow of vertebra where the lesion was located and in adjacent vertebrae [Figures and ]. After the application of paramagnetic contrast agent, a heterogeneous mild enhancement was noticed on the lesion and intense medullary bone marrow enhancements were seen on adjacent bone structure. Intense enhancement was observed on the left apical pleural surface and soft tissues around the truncus, on left C7-T2 nerve roots, and paravertebral soft tissues adjacent to the lesion [Figures and ]. Although MRI findings of the lesion showing extensive edema in surrounding tissues suggested osteoid osteoma, CT examination was performed to make a more detailed evaluation of vertebral bone structures and to confirm the diagnosis. A well-contoured hypodense lesion showing typical osteoid osteoma features having heterogeneous hyperdense calcified bone matrix in T1 vertebra left lamina-transverse process junction was observed on cervicothoracic vertebra CT. Density increase concordant with intense sclerosis was noticed on adjacent bone structures []. After the operation, pathologic diagnosis confirmed the radiologic diagnosis of osteoid osteoma.