Primary calcaneal aneurysmal bone cyst in a 5-year-old treated with serial polidocanol sclerotherapy: a case report

Aneurysmal bone cyst (ABC) is rarely seen in the calcaneus of young children. To our knowledge, till date very less number of calcaneal ABC have been reported in the literature. A 5-year-old female child suffered chronic heel pain for last 2 months and was presented with x-ray showing a solitary and expansile osteolytic lesion within the calcaneus. Detailed clinico-radiological and histopathological examination suggested the lesion as ABC. The volume of the lesion was 11.9 cm3 as measured in the MRI. Curettage was not opted as wall of entire calcaneus was very thin and lesion was big compared to the age of child. Treatment was done with 4 sequential sclerosant polidocanol injection therapy over 9months, with minimum of 6 weeks interval in each injection. Dosage of the sclerosant therapy was calculated by weight of the patient (2-4 mg/kg) instead of volume of the cyst. No recurrence was observed over next 1 year by sequential X-rays. Age of the patient, anatomical location and severity in our case makes it unique. ABC can also be found in unusual locations like calcaneus even at 5 years age and can be managed by standard polidocanol protocol. In very young children with thin-walled, calcaneal ABCs, serial sclerosant injection may avoid morbid curettage/grafting.