Presentation
Left sided jaw swelling. Some pain on eating. No other joint pain.
Patient Data
Asymmetric mandible with expansion and increased sclerosis of the left mandibular body and ramus with associated periosteal reaction.
There is expansion of the left mandibular body. T2 hyperintense and T1 hypointense. Surrounding soft-tissue edema, but no soft tissue mass. No other lesions.
Case Discussion
The differential in this case is between a primary agressive bone tumor (e.g. Ewing sarcoma) or a process such as LCH or an inflammatory osteitis (e.g. CRMO).
A whole body MRI is useful to determine whether there are other lesions that might narrow the differential or offer another site for biopsy.
In this case, there were no other abnormalities.
A biopsy was performed that excluded an underlying neoplastic process and the diagnosis of CRMO was made. Treatment resulted in a reduction of the periostotic inflammation and improved pain control.
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