Value of 99mTc-HMDP in the exploration of melorheostosis

摘要

The melorheostosis is a rare osteopathy, often monomelic of chronic evolution corresponding to a osteosclerosis with hyperostosis into cast whose etiopathogeny remains unknown.We report the observation of a melorheostosis of the lower limb occurring in a 38 years old patient. Radiography made it possible to direct the diagnosis towards the aspect of an endostosis bone condensation, into cast of candle, interesting in a unilateral way the skeleton of the left lower limb (femur and tibia). The bone scintigraphy corroborated the diagnosis by highlighting a rather intense uptake of the tracer at the level of the left femoral diaphysis exceeding the periostosis and invading the soft parts partially. A moderate uptake was also noted compared to the higher half of the left fibula. A synovectomy of the knee was carried out with double recovery. The evolution was marked by a clear attenuation of the pain. Introduction The melorheostosis is a rare osteopathy which etiopathogeny is still obscure, described for the first time in 1922 by Leri and Joanny like a osteosclerosis with a hyperostosis in casting. The melorheostosis prevails in a sporadic state and does not seem to take an hereditary form. We report, through this work, a rare case of this pathology. Case report A 38 years old patient without particular antecedent having consulted for a painful tumefaction of the left lower limb answering partially to analgesic treatment with stiffened knee in light inflection.Haut du formulaireThe clinical examination objectified a clear asymmetry of the two lower limbs at the expense on the left side with a tumefaction prevailing in the level of the left thigh and leg. The examination of the left knee reveals a very painful inflection, limited to 70°. The remainder of somatic examination was without particularity characteristic.Radiography showed an osseous condensation interesting endostosis with thickening of external cortical, in run candle, on all the femoral diaphysis and the higher half of the left fibular diaphysis (Figures 1).