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Irregular eccentric cortical thickening involving the medial aspect of the right femur with intramedullary extension and giving the appearance of dripping candle wax consistent with melorheostosis. There are bilateral osteoarthritic changes more pronounced on the left.
Melorheostosis is a hyperostosis commonly affecting the long bones in a sclerotome distribution. The dripping candle wax sign is classic for melorheostosis and describes the thickened and irregular cortex. This bone dysplasia is usually asymptomatic and seen incidentally on radiographs, as in this patient who has been followed up for knee osteoarthritis.