PMC6020456_01
Orthopantomography. Sclerotic changes are seen in the right body of the mandible with periosteal reaction (arrows).
CRIRA2018-9142362.001.jpg
PMC6020456_01_CRIRA2018-9142362.001.jpg
fig1
Orthopantomogram showed sclerotic change at the right body of the mandible with periosteal reaction (Figure 1).
CT scan of the mandible. Axial (a) and coronal (b) and oblique sagittal reconstruction (c) plain CT images show sclerotic change and periosteal reaction in the right body of the mandible (arrows). Spotted osteolysis is also seen mainly in the cortical bone (arrowheads).
CRIRA2018-9142362.002.jpg
PMC6020456_01_CRIRA2018-9142362.002.jpg
fig2
Plain computed tomography (CT) showed sclerotic change at the right body of the mandible with periosteal reaction and spotted osteolysis was seen in the cortex of the mandible (Figure 2).
MR imaging of the mandible. Axial (a) and coronal (c) T1-weighted images and axial T2-weighted image (b) show thickening of the right mandible (arrows) and decreased bone marrow fat signal (arrowheads). Coronal short tau inversion recovery image (d) shows high signal intensity in the right body of the mandible (arrow), with perilesional soft tissue swelling (arrowhead).
CRIRA2018-9142362.003.jpg
PMC6020456_01_CRIRA2018-9142362.003.jpg
fig3
On magnetic resonance imaging (MRI), the right body of the mandible showed low signal intensity on T1-weighted images and high signal intensity on short tau inversion recovery (STIR) images with perilesional soft tissue swelling (Figure 3).
Bone scintigraphy. There is increased tracer uptake in the right mandible (arrow), sternum, and the sternocostoclavicular joints (dotted circle).
CRIRA2018-9142362.004.jpg
PMC6020456_01_CRIRA2018-9142362.004.jpg
fig4
To investigate the presence of other osteoarticular involvement, technetium-99m hydroxymethylene diphosphonate (99mTc-HMDP) scintigraphy was performed, which demonstrated diffuse increased uptake at the right mandible, as well as in the sternum and the sternocostoclavicular joints (Figure 4).
Histopathological findings of the mandible. Enlarged and sclerotic bone trabeculae with little inflammatory cell infiltration [hematoxylin-eosin staining; magnification: 100x (a), 400x (b)].
CRIRA2018-9142362.005.jpg
PMC6020456_01_CRIRA2018-9142362.005.jpg
fig5
Histopathological examination showed enlarged and sclerotic bone trabeculae with little inflammatory cell infiltration, which was compatible with SAPHO syndrome (Figure 5).