Figure 1
Left index finger - lateral view
Irregular endosteal sclerosis along the major axis of the 2nd proximal phalanx and almost complete sclerosis of the middle and distal phalanges, including their epiphyses.
Chicken or egg scenario - which came first?
SectionMusculoskeletal system
Case TypeClinical Cases
AuthorsG. Klafkowski, A. Camenzuli, M. Caplan, R. Vinayagram.
Connected authors
10 years, female
Clinical History
The patient presented with a painful left index finger after a trivial sport-related injury. AP and lateral views of the left index finger and subsequently an AP view of the left hand were performed.
Imaging Findings
The patient presented with a painful left index finger after a trivial sport-related injury. Initially AP and lateral views of the left index finger were performed. After initial inspection of these views it was decided to obtain an AP view of the whole of the left hand including the wrist. On examination the patient had full range of movement and no skin abnormalities were detected.
Both the dedicated views of the left index finger and the radiograph of the left hand demonstrated irregular endosteal linear areas of increased density along the major axis of the 2nd and 3rd metacarpals and the 1st, 2nd and 3rd proximal phalanges. These were encroaching on the medulla, but were primarily cortically based. The adjacent epiphyses were also involved to varying degrees. Additionally, there was almost complete sclerosis of the 2nd and 3rd middle and distal phalanges and their epiphyses. There were also irregular areas of sclerosis in the lunate, trapezoid and capitate. Joint fusion, shortening of the involved bones or ossified soft tissue masses were not seen. Unfortunately, no radiographs of the contralateral hand were available for comparison.
The appearances are consistent with melorheostosis.
Discussion
Melorheostosis is a non-genetic disease of unknown aetiology. It is usually unilateral, asymmetrical and the most common site is in the diaphyses of the lower limb. Sclerotic linear streaks along the long axis of the affected bone, which are often likened to "dripping candle wax", are seen. The epiphyses may also be affected. Soft tissue calcification and ossification with a periarticular predisposition may occur. Melorheostosis can be asymptomatic but may also present with pain, soft tissue contracture and indurating skin lesions.
In this patient the finding may be incidental and her pain attributed to soft tissue injury, or the pain may be due to the melorheostosis. Time will tell!
Differential Diagnosis List
Melorheostosis
Final Diagnosis
Melorheostosis
References
[1]
Wynne-Davies R. Sclerosing bone dysplasias.
In Wynne-Davies R, Hall CM, Apely G. Atlas of skeletal dysplasias.
Churchill Livingstone, London, pp 508-11 (1987).
[2]
Dahnert W. Bone and soft-tissue disorders.
In Dahnert W (4th ed). Radiology review manual.
Williams and Wilkins, Baltimore, pp 93 (1999).
[3]
Sartoris DJ. Congenital disorders.
In Sartoris DJ. The requisites: musculoskeletal imaging.
Mosby, St Louis, pp 328-30 (1996).
Case information
| URL: | https://www.eurorad.org/case/1356 |
| DOI: | 10.1594/EURORAD/CASE.1356 |
| ISSN: | 1563-4086 |
Figure 2
Left hand - AP view
Similar appearances as seen in the index finger are also seen in other bones of the left hand, including irregular areas of sclerosis in the lunate, trapezoid and capitate.
Left index finger - lateral view
Irregular endosteal sclerosis along the major axis of the 2nd proximal phalanx and almost complete sclerosis of the middle and distal phalanges, including their epiphyses.
Left hand - AP view
Similar appearances as seen in the index finger are also seen in other bones of the left hand, including irregular areas of sclerosis in the lunate, trapezoid and capitate.