Findings: Images #1 and 2 are plain films of the tibia demonstrating peripherally located hyperostosis producing a wavy sclerotic bony contour along the tibial diaphysis.

There are similar findings involving the first metatarsal as well as the navicular and first cuneiform bone. In addition, there are soft tissue calcifications adjacent to the navicular and cuneiform.

Diagnosis: Melorheostosis.

Discussion: Melorheostosis is a rare disorder of bone which generally presents in early childhood. There are no known hereditary factors. The initial clinical presentation includes diffuse joint pain as well as swelling with associated limitation of motion. Other potential complications include muscle contractures as well as soft tissue involvement including calcifications. More severe cases will demonstrate growth disturbance which may lead to scoliosis, contractures, and deformities which may be severe.

Radiologic manifestations are most commonly limited to a single limb, although multiple limbs may on occasion be involved. Melorheostosis most commonly involves the lower extremity, and is rarely see in the skull, facial bones, and ribs. The findings most commonly consist of osseous excrescences extending along the length of a bone simulating the appearance of "candle wax" dripping down the side of a candle. In the carpal and tarsal bones, there may be more discrete rounded regions of bony sclerosis as well as adjacent soft tissue calcifications. Nucleide scintigraphy cases of melorheostosis demonstrate a region of increased nucleide uptake. MR imaging demonstrate regions of decreased signal intensity on all pulse sequences.

Reference:
Resnick D. Bone and Joint Imaging. W. B. Saunders, 2nd Edition, Philadelphia. 1996;1215.

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