Fibrous dysplasia in tibia

Case contributed by Dr Erik Ranschaert

Presentation

This 23-year old man mentioned to have had a trauma and was now complaining of pain and swelling in the left lower leg.

Patient Data

Age: 23
Gender: Male

X-ray of the tibia

Modality: X-ray

A lytic lesion is demonstrated in the left lower tibial diaphysis with ground-glass appearance, endosteal thinning of the cortex and some ballooning of the shaft. No periosteal reaction is seen.

Bone scan

Modality: Nuclear medicine

Three phase dynamic bone scintigram (only delayed images shown here) demonstrates a hot spot in the left tibia caused by increased uptake of the radioisotope tracer technetium-99m methylene diphosphonate (99m Tc MDP). The increased uptake is already visible in the early phase.

MRI tibia

Modality: MRI

Magnetic resonance imaging (MRI) shows typical features with low-to-intermediate signal intensity equal to that of muscle on T1-weighted images. T2-weighted images also show low signal intensity owing to the high content of collagen and bone. A mild and homogeneous enhancement pattern of the lesion is seen after Gadolinium. 

Distribution of fibrous dysplasia

Modality: Diagram

Distribution of monostotic fibrous dysplasia. Layout and distribution: Frank Gaillard 2012, Line drawing of skeleton: Patrick Lynch 2006, Creative Common NC-SA-BY

Case Discussion

Fibrous dysplasia is a skeletal developmental anomaly of the bone-forming mesenchyme that manifests as a defect in osteoblastic differentiation and maturation. Virtually any bone in the body can be affected. It is a nonhereditary disorder of unknown cause.

In this case the diagnosis is straightforward as typical features are present. X-ray is still the examination of first choice. For postoperative follow-up, gadolinium-enhanced MRI can be useful in demonstrating the proliferation of fibrocellular tissue.

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Case Information

rID: 14236
Case created: 9th Jul 2011
Last edited: 6th Oct 2015
Inclusion in quiz mode: Included

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