Presentation
Ride sided lower extremity pain. Palpable bump on the tibia.
Patient Data
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Multiple linear areas of sclerosis are present involving the distal tibia and first ray oriented along the long axis of these bones, with undulating cortical thickening most prominently along the anterior tibia and medial 1st metatarsal.
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The anterior tibial cortex is thickened, with and undulating contour along the periosteal surface of the anterior cortex giving a "dripping candle wax" appearance. Linear areas of sclerosis are present within the proximal and distal metaphyses, oriented along the long-axis of the tibia. The patella and distal femur appear to have similar findings.
There is cortical thickening of the right iliac crest and anterior surface, as well as along the acetabular roof. Linear areas of sclerosis are present subject to this. The right proximal femur also has a thick sclerotic cortex medially with scattered areas of medullary sclerosis.
Case Discussion
Typical case of polyostotic melorheostosis following a sclerotomal distribution, with the characteristic "dripping candle wax" appearance of the thickened cortex along the periosteal surface of involved sites.
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