[Case History] T his male patient has a history of multiple traumas to his humcrus. Are these radiopacitics exuberant callous formation from hematoma? Diagnosis: The answer is no!! This is a rare sclerotic skeletal dysplasia referred to as "MELORHEOSTOSIS". General Considerations Mclorhcostosis is a rare, sclcrosing bone dysplasia that was first described in 1922 by Lcri and Joanny. Synonyms include Leri type ofosteopetrosis, osteosis eberneizzante mononwlica, and flowing hyperostosis. The name melorheostosis is oiCireek derivation, meaning limb, flow, and bone, and aptly describes the hyperostotic appearance that has been likened to wax flowing down a lighted candle. Radiologic Findings Cortical thickening in a streaked or wavy pattern is the most marked rocntgen feature. In children the hyperostosis is primarily endostcal: in adulthood, pcriostcal bone deposition is more dramatic.('' The radiographic findings appear to reflect developmental errors at the sites of intramembranous and en-chondral bone formation. <' > The hyperostotic bone protnidcs under the periosteum and usually follows along one side of a long bone. Endostcal involvement may encroach upon the medullary space. Bony masses resembling osteochondromas extend into adjacent articulations. Involvement of the carpal and tarsal bones resembles the multiple bone islands that arc seen in osteopoikilosis. In the pelvis and scapulae (flat bones) the sclerotic bone may be in the form of dense radiations from the joint. Heterotopic bone formation and soft tissue calcification are encountered and may lead to joint ankylosis. Bone scintigraphy shows increased tracer uptake in the involved area. A number of other disorders have been found in association with mclorhc-ostosis. These include linear sclcrodcrma. osteopoikilosis. ostcopathia striata. ncurofibromatosis. tuberous sclerosis, and hemangiomas.(l) Dr. Terry R. Yochuni is a second generation chiropractor and a Cum Laude Graduate of Xalional College of Chiropractic, where he subsequently completed his radiology residency. He is currently Director of the Rocky Mountain Chiropractic Radiological Center in Denver, Colorado, and Adjunct Professor of Radiology at the Southern California University of Health Sciences, as well as an instructor of skeletal radiology at Ihe L'niversily of Colorado School of Medicine, Denver, CO. Dr. Yochum can be reached at 1-303-940-9400 or by e-mail at dcrad099iaaol.com Dr. Alicia M. Yoclnim is a third generation chiropractor and 2011 Stima C 'tun I.aude Graduate of Logan College of Chiropractic, as well as a Registered Xur.se. She is starling her Radiology Residency at Logan College in April 2012. She can be reached at alicia.yochum@ gmail.com. Reference: l.Yochum TR, Rowc LJ: Essentials of Skeletal Radiology. 3rd cd.. Williams & Wilkiiis. Baltimore. Man land. 2005. BBT8
