Keywords:
Bones, Musculoskeletal bone, Extremities, Conventional radiography, CT, MR, Diagnostic procedure, Screening, Education, Genetic defects, Pathology
Authors:
K. Maniatis, G. Georgiades, E. Markou, A. Balanika; Athens/GR
DOI:
10.1594/essr2018/P-0087
Background
The term intramedullary osteosclerosis (IMOS) was first introduced by Abdul-Karim in 1988.
It is a rare nonhereditary ,idiopathic pathological condition characterized by asymmetrical osteosclerosis and endosteal new bone formation in the medullary cavity of long bones.
It has female predominance;it occurs in young adults and in the beginning of middle age.
The sclerosis typically involves the medullary cavity of the diaphyseal portion of the lower extremities,
most frequently the tibia,
with no essential periosteal reaction or soft-tissue abnormality.
IMOS may be unilateral or bilateral and polyostotic,
with no history of trauma and infection.
Physical examination reveals no cutaneous stigmata,
leg deformities,
or leg length discrepancies.
Patients often experience persistent,
mild to moderate,
intermittent,
activity-irritated-related pain,
unrelieved by non steroidal anti inflammatory drugs that referred to the sites of radiographic abnormalities.
Importantly,
the laboratory test results (complete blood count,
erythrocyte sedimentation rate,
C-reactive protein value,
serum electrolytes and serum alkaline phosphatase levels) are normal.
The diagnosis of IMOS is based on the exclusion of several skeletal disorders associated with bone sclerosis such as trauma (healing stress fracture),
atypical femoral fractures (AFFs,
associated with antiosteoporotic therapy with bisphosphonate)malignancy (osteosarcoma,
lymphoma,
osteblastic metastasis),
infections (chronic osteomyelitis),osteoid osteoma,
metabolic disorders (renal osteodystrophy,
hypervitaminosis A,
pseudohypoparathyroidism,
and pseudopseudohypoparathyroidism) or sclerosing bone dysplasias.
As far as we know,
few cases of IMOS have been reported in the literature.
We present imaging findings of IMOS in an elderly woman with lower leg pain that is exacerbated by physical activity,
with no history of trauma and a history of breast cancer.
The diagnosis was confirmed by excluding clinically and radiologically other causes.