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1 What’s the Diagnosis - Case 8 History 60 year old man with lateral, right sided knee pain.
1What’s the Diagnosis - Case 8
History60 year old man with lateral, right sided knee pain.
2What’s the Diagnosis - Case 8
3What’s the Diagnosis - Case 8
4What’s the Diagnosis - Case 8
FindingsCortical thickening is present along the lateral aspect of the proximal femur and tibia in a sclerotomal distribution with additional thickened and enlarged trabeculae noted of the femoral condyle. In addition, there is prominent inflammatory change noted deep to the iliotibial band in the soft tissue adjacent to the bony changes.
5What’s the Diagnosis - Case 8
6What’s the Diagnosis - Case 8
7What’s the Diagnosis - Case 8
8What’s the Diagnosis - Case 8
Diagnosis - MelorrheostosisComments: A benign bony proliferative process typically identified in early adulthood but sometimes becoming symptomatic only later in adult life when there is pain and limitation of joint movement secondary to bony encroachment. Additionally, there may be adjacent soft tissue inflammation as in this case which is precipitating an il-iotibial band friction type syndrome. There is a typical candle wax cortical thickening and trabecular condensation in a sclerotomal (distribution of the skeleton supplied by a sensory nerve) distribution. In approximately one quarter of the cases, soft tissue masses with calcification are seen.
9What’s the Diagnosis - Case 8
Resources
• Resnick and Kransdorf. Bone and Joint Imaging. 2005.
• Woolridge B. Stone NC. Denic N. Melorheostosis isolated to the calcaneus: a case report and review of the literature. [Review] [16 refs] [Case Reports. Journal Article. Review] Foot & Ankle International. 26(8):660-3, 2005 Aug. • Rhys R. Davies AM. Mangham DC. Grimer RJ. Sclerotome distribution of melorheostosis and multicentric fibromatosis. [Review] [16 refs] [Case Reports. Journal Article. Review] Skeletal Radiology. 27(11):633-6, 1998 Nov. UI: 9867181
Further Reading• Hospital for Special Surgery Manual of Rheumatology and Outpatient Orthope-
dic Disorders, Ch. 39 - Ankylosing Spondylitis
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