Diagnostic diffi culties posed by the talar neck osteoid osteoma

Abstract

The aim of this report is to emphasize diagnostic diffi culties posed by osteoid osteoma of the talar neck. Besides the nonspecifi c clinical fi ndings, osteoid osteoma of these localizations is often diffi cult to notice on magnetic resonance imaging, which is the fi rst choice diagnostic imaging method for painful joints. A case is reported of a 15-year-old female patient who began to feel pain in her left ankle with no preceding injury. During the following treatment period, magnetic resonance imaging was performed on two occasions and arthroscopic surgery was performed, but did not lead to recovery. After detailed history taking and physical examination at our Department, osteoid osteoma of the talar neck was suspected and computed tomography was performed afterwards, confi rming the diagnosis. Arthroscopic surgery was performed once again, during which partial synovectomy was done and the tumor removed, with histopathologic analysis confi rming the diagnosis of osteoid osteoma. The patient was pain-free after the surgery, both during loading and resting of the ankle, completely returning to recreational sports six months later. Intra-articular and juxta-articular osteoid osteoma can often have a nonspecifi c clinical presentation, which can be misleading, delaying correct diagnosis and thus the beginning of eff ective treatment. When osteoid osteoma of the talar neck is suspected, computed tomography is the imaging method of choice, but also good communication between the clinician and the radiologist is required because the chance of accurate diagnosis will be signifi cantly higher if the radiologist is familiar with the suspicion of osteoid osteoma.