PMC1784091_01
clinical synopsis of a 6 years old girl with a history of short stature. Figure 1a shows the patient at the time of suspected growth hormone releasing hormone failure. 2 months after growth hormone therapy started a painful swelling of the cheek was noted (figure 1c) which worsened at the time of presentation 3 months later (figure 1d). Initial magnetic resonance imaging (MRI) was normal (figure 1b: T2-weighted transversal image (slice thickness 5 mm)). Subsequent MRI 5 months later did show a diffuse bone lesion affecting the os zygomaticum and involving surrounding soft tissue (figure 1e: Fat saturated strongly T2-weighted transversal image (slice thickness 5 mm)). Malignancy could not be excluded. Computed tomography revealed hyperostosis in addition to osteolysis (arrows) of the cortical bone (figure 1f). Conventional x-ray of the right hemithorax showed hyperostosis of the anterior 4th rip (figure 1g). Technetium 99m-MDP bone scan showed the involvement of the os zygomaticum and the clinically silent costal lesion (figure 1h). 1 year of non-steroidal anti-inflammatory treatment induced clinical remission (figure 1i). MRI did show a very small signal elevation in the area of the biopsy (figure j: Fat saturated strongly T2-weighted transversal image (slice thickness 5 mm)).
1471-2431-7-3-1.jpg
PMC1784091_01_1471-2431-7-3-1.jpg
F1
The treatment rapidly reduced clinical symptoms including pain and soft tissue swelling (figure 1i). MRI analysis after 3, 6 and 12 months revealed subsequent reduction of bone marrow oedema and local gadolinium enhancement. 12 months later MRI showed almost unremarkable lesions (figure 1j). Mild hyperostosis of the os zygomaticum was still present after 12 months at treatment cessation. 24 months later the patient was still in remission.
clinical synopsis of a 10 years old girl with a history of back pain. Technetium 99m-MDP bone scan (figure 2a and b) shows the rib and multiple osseous spine lesions at diagnosis. Initial magnetic resonance imaging (MRI) revealed a compression of vertebra #9 and 11 (figure 2c: T1-weighted sagittal image (arrows); figure 2d: T1-weighted sagittal image after i.v. gadolinium enhancement), in addition to oedematous changes predominantly in the 8th vertebra (figure 2e: strongly T2-weighted sagittal image; arrow). Subsequent MRI 12 months later no longer showed oedematous changes, however the vertebral compressions were still present (figure 2f: T1-weighted sagittal image (arrows); figure 2g: T1-weighted sagittal image after i.v. gadolinium enhancement; figure 2h: strongly T2-weighted sagittal image).
1471-2431-7-3-2.jpg
PMC1784091_01_1471-2431-7-3-2.jpg
F2
At first these were considered trauma related, however, especially posterior oedematous changes of the 8th vertebra were considered not to be typical sequels of a trauma (figure figure 2c-e). In addition, a technetium bone scan did show an additional lesion in the right 4th rib (figure 2a,b). Parallel to this clinical improvement subsequent MRI analysis (figure 2c-e) after 3, 6 and 12 (figure 2f-h) months revealed subsequent reduction of bone marrow oedema and local gadolinium enhancement. 12 months later MRI showed an unremarkable 8th thoracic vertebra, whereas the 9th and 11th still showed compression without sign of acute inflammation (figure 2f-h).