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
Conclusion
IMOS is an uncommon benign condition of unkown aitiology.
The diagnostic approach is based on the patient’s demographics,
the medical and accurate family history,
the clinical and laboratory (blood tests)and imaging( X-rays,
MRI,
C/T and Bone Scintigraphy) findings.
In our case,
we investigated the antalgic gait of an old age female patient with sclerotic intamedullary lesions on radiograph of the left femur.
Firstly the possibility of healing stress fracture or AFFs (associated with bisphosphonate therapy for osteoporosis) ruled out due to the absence of a localized periosteal or endosteal thickening and of a transverse or oblique fracture line within.
The absence of increased vascularity on initial flow images of triphasic bone scan and the low signal intensity in all MR sequences without periosteal reaction and/or soft tissues abnormalities ruled out the probability of osteoblatic metastasis,
malignancy and bone infection.
There was no radiolucent nidus in dense sclerotic bone,
so the possibillity of osteoid osteoma was excluded.
The lack of soft-tissue changes,
diffuse osteoclerosis,
abnormal laboratory and clinical features virtually exclude the diagnosis of IMOS,
in the differential diagnosis of metabolic disorders.
Camurati-Engelmann and Ribbing disease are sclerosing bone dysplasias with imaging features closely parallel those to IMOS.
The genetic character of these diseases,
male predominance,the particular clinical manifestations and the younger age’s appearance ruled out the possibility.
Although IMOS is a rare entity,
which it should be considered in elderly patients with analgesic gait and sclerotic intramedullary midshaft lesions in long bones radiographs.
It is important that IMOS is a diagnostic challenge and an exclusion diagnosis.
Clinical,
medical and family history and the results of laboratory tests associated with imaging findings allow accurate diagnosis.