Case report of a rare giant bone island in a vertebral body combined with hemangioma

This case report describes a rare giant bone island combined with hemangioma diagnosed in a patient with osteolytic vertebral metastases. The bone island’s greatest diameter was 3.15 cm, and bone islands of this size are rare in the literature. This article aims to provide clinicians with information about the diagnosis and relevant literature of bone islands.

Atypical Enostoses—Series of Ten Cases and Literature Review

Bone islands (BI; enostoses) may be solitary or occur in the setting of osteopoikilosis (multiple bone islands) and are sometimes associated with Gardner’s Syndrome (osteopoikilosis and colonic polyposis). Characteristic features of bone islands are (1) absence of pain or local tenderness, (2) typical radio dense central appearance with peripheral radiating spicules (rose thorn), (3) Mean CT (computerized tomography) attenuation values above 885 Hounsfield units (HU) (4) absence of uptake on bone scan and (5) radiographic stability over time. However, when enostoses display atypical features of pain, unusual radiographic appearance, aberrant HU, increased radiotracer uptake, and/or enlargement, they can be difficult to differentiate from more sinister bony lesions such as osteoblastic metastasis, low grade central osteosarcoma, osteoid osteoma and osteoblastoma. In this retrospective case series, the demographic, clinical, radiographic, treatment and outcome for ten patients with eleven atypical bone islands (ABI) are presented, some showing associated pain (5), some with atypical radiographic appearance (3), some with increased activity on BS (4), some with documented enlargement over time (7), one with abnormal CT attenuation value, some in the setting of osteopoikilosis (2), one in the setting of Gardner’s Syndrome and one osteoid osteoma simulating a bone island. This series represents the spectrum of presentations of ABI. Comprehensive review of the literature reveals that the previous largest series of ABI showing enlargement as the atypical feature was in younger patients with jaw BI. Hence, this represents one of the largest series reported of ABI of all types in adults.

An incidental dense bone island: A review of potential medical and orthodontic implications of dense bone islands and case report

Dense bone islands (DBIs) are usually asymptomatic and do not require any treatment. This case report presents a DBI of an unusual presentation, which was an incidental finding on a radiograph of a 15-year-old orthodontic patient. The DBI lesion was 24 mm in size, occupying at least 50% of the alveolar process between the upper right canine and lateral incisor, extending up the lateral aspect of the anterior margin of the right nasal fossa. Generally, DBIs are 2–3 mm in size and more commonly found in the mandible in the molar and premolar region. This article further discusses the impact of DBIs on orthodontic treatment such as difficulty with achieving space closure and adequate root tip or torque. We also examine the potential medical implications of DBIs. This is clinically important, especially if multiple DBIs, or osteomas which have a similar radiographic appearance to DBIs, are found in a patient as they may be associated with adenomatous intestinal polyps, which, if not treated, have a 100% chance of becoming malignant transformation

Temuan insidental dense bone island pada radiograf panoramik

Objectives: The aim of this study is to increase knowledge about Dense Bone Island diagnosis and differential diagnosis as well as emphasize on radiographic characteristics of this lesion. Case Report: A male 24 years came to the Dentomaxillofacial Radiology Installation, Faculty of Dentistry Dental Hospital Universitas Padjajaran referred for radiographic examination from the Periodontics Department. The patient will be paired dental implants in the second premolar in the right mandible. Patients had no inflammation and pain. The patient then were take radiography examinations as indicated dental implant, that were periapical, panoramic and CBCT, then one of the radiographic examination was done, the panoramic which shows radiopaque, well-defined, rounded irregularly shaped lesion with a diameter of approximately 6 mm, which is located around apical first premolar teeth in the right mandible. Mandible first premolar is still vital. Conclusion: Dense bone Island is an increased bone density that occurs in the maxilla or mandible especially around the root of a tooth, and is often asymptomatic. Cases that occur in these patients have no clinical complaints either before or after the installation of dental implant.

Bone islands incidentally detected on computed tomography: frequency of enostosis and differentiation from untreated osteoblastic metastases based on CT attenuation value

Objective: The frequency of enostosis incidentally found on CT and CT attenuation value to distinguish them from untreated osteoblastic metastases (UOM). Methods: Enostosis group: 46 polytrauma patients underwent thoracoabdominal CT. Inclusion criteria: age range 14–35 years. Exclusion criteria: cancer, previous fractures. UOM group: 20 patients with radiological diagnosis of UOM. Analyzed data: number, size, location and density of enostoses and metastases. The density was measured with the broadest possible region of interest at the center of the lesion by two radiologists independently. Receiver operatingcharacteristic analysis to determine the sensitivity and specificity, area under the curve 95% confidence intervals and cutoff values of CT density to differentiate metastases from enostoses. Results: Patients were 28 ± 7 years old (72% males). 41 (89%) patients had 124 enostoses (2–15 mm) with an average density of 1007 ± 122 Hounsfiled unit (HU, observer1) and 1052 ± 107 (observer2). The most common sites of occurrence were the proximal femur (34%), the pelvis (22%), the acetabulum (20%), the proximal humerus (11%), the vertebrae (11%) and the rib (2%). 13 patients had 1 bone island, 8 patients had 2, 9 cases had 3 and 11 cases had more than 3 enostoses. Overall, 114 UOM were evaluated, their average density was 728 ± 163 HU (observer1) and 712 ± 178 HU (observer2). The area under the curve value of mean density to distinguish enostoses from UOM was 0,982. Using a cut-off of 881 HU for mean density, sensitivity was 98% and specificity 95%. Conclusion: The frequency of enostosis in this study is 89%. The average density identified can help to distinguish enostoses from UOM. Advances in knowledge: We report the exact frequency of enostosis.

Temuan insidental lesi radiopak asimptomatik pada pemeriksaan radiografi panoramik: laporan 3 kasus dan ulasan pustaka Dense Bone Island (DBI)

Objectives: Dense Bone Island (DBI) is one of the lesions that are usually visualized on a panoramic radiographs in the form of total radiopaque in the periapical area of the mandibular premolar or molar but most of them are not directly related to the dentition. This case report is aimed to give summaries about the description of 3 DBI cases. Case Report: Three panoramic radiographs of patients with asymptomatic well-defined radiopaque lesions which was found incidentally in the periapical area of the left mandibular first premolar with two of them showing the lesions located exactly in the 1/3 apical of the root and one of them seen as root resorption like. From clinical information, all three cases reported no clinical symptoms and affected teeth are still vital. Conclusion: Incidental findings of well-defined radiopaque lesion in the periapical area of the premolar and molar of mandible that mostly do not damage the surrounding teeth lead to the diagnosis of dense bone island.