Any thoughts on what this could be? He's having a rough day again today..hopping around the house. Any suggestions are welcome? Is this familiar to anyone?
Well, it would be difficult for me to give a precise opinion without a detailed clinical evaluation. From what I gather from your description, there as a peri-osteal reaction observed in the primary images, while further images ruled out an osteoid sarcoma. Since the CT and the bone scans have not revealed much (as I understand after evaluation by several radiologists/ orthopedicians), this is unlikely to be a serious primary bone issue. Soft tissue abnormalities and bone marrow issues could also lead to periosteal reaction and these may not be as clear on the CT and may require an MRI. I guess the reaction has gradually settled over the months. With the primary tests I would have suggested conservative management with rest, anti-inflammatory medications/ pain killers as well. At this stage I would suggest reviewing the MRI images as well with the CT/ PET/ bone scans. If anything specific is found it would be managed accordingly, while empirical conservative management may be continued meanwhile.
Hope this is helpful.
Thank you for your response Dr. Kaul!
I know it is difficult without the clinical exam, but in your opinion, would the possible "soft tissue abnormalities or bone marrow issues" be harmless enough or should we try to get the MRI sooner than 3 months from now.
For pain reasons alone, I am tempted to get the MRI moved because his pain is nearly constant again. It is quite difficult to manage this with "rest" because he is a very typical 5 yr old boy. He rarely stops - he just compensates with hops or limps. He is other leg is also sore at times from the extra work it's doing. We are hoping to see a pain clinic within a couple of weeks.
Anyway, my bigger concern: is it possible this is some type of cancerous soft tissue issue that we should not be waiting 3 months for MRI. (If we travel, we can get the MRI sooner).
I do not see a a huge benefit in getting the MRI scheduled earlier. I understand how one feel when its ones child involved. It it was something gross, it would have been picked up by the CT/ basic blood tests. If you can get the MRI scheduled earlier without any extra expense or liability, it might be an option worth considering; otherwise a couple of months wait should not be harmful.
He hasn't had blood work...perhaps we should request that. Our doc was so confident that it was going to be an Osteoid Osteoma that he didn't request blood work.
(When we saw pain improvement with the cast on, it was as though he stopped looking for a diagnosis. )