Aneurysmal Bone Cysts (ABCs) are benign, expansile lesions representing 2.5% of primary bone tumours, most often affecting children and adolescents. Traditional surgical approaches, such as curettage or wide local excision, carry recurrence rates of up to 70%, emphasising the need for less invasive and more effective alternatives. Image-guided sclerotherapy with agents including doxycycline has emerged as a promising interventional option. We present a case of recurrent tibial ABC successfully treated with single-session CT-guided percutaneous sclerotherapy. A teenage boy presented with 2 month history of right ankle pain and swelling following minor trauma to the area. Radiographs demonstrated an expansile, multiloculated, cystic lesion in the distal tibial metaphysis. Subsequent MRI showed multiple fluid-fluid levels, circumferential periostitis and mid para-osseous oedema of the distal tibia. Biopsy confirmed the diagnosis of ABC. The patient underwent curettage with allograft, followed by wide local excision and external fixation after recurrence within 6 months. 1-year surveillance CT again demonstrated recurrence and following multidisciplinary tumour board discussion and repeat biopsy, CT-guided percutaneous doxycycline sclerotherapy with bone void filler was performed. Under general anaesthesia, two 11G bone access needles were advanced into the cystic portion via a posterolateral approach. After aspiration and contrast injection with no spillage demonstrated on CT, doxycycline liquid was instilled and allowed to dwell before being aspirated and bone void filler instilled. The procedure was uncomplicated - the patient was discharged the same day. At 11-month follow-up, the patient reported no pain, had returned to full activity and demonstrated radiographic consolidation without recurrence. This case highlights the value of CT-guided percutaneous sclerotherapy as a minimally invasive alternative for recurrent ABC, particularly in skeletally immature patients where repeat open surgery risks growth plate injury, deformity, and functional impairment. Compared with multiple-session doxycycline-albumin foam regimens reported in the literature, our case demonstrates successful consolidation with a single-session doxycycline alone injection. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Meti Shraddha, Porter Daniel, Ali Khalid, Watkins Linda

Keywords: Aneurysmal Bone Cyst, Sclerotherapy, Image-Guided