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Leong AWS, Langdon J, Malhotra V, Mandalia U. A case of spinal melorheostosis. COSMODERMA 2022; 12:8. [PMID: 35251764 PMCID: PMC8890114 DOI: 10.25259/jcis_202_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/02/2022] [Indexed: 11/18/2022]
Abstract
Melorheostosis is a rare bone dysplasia of unknown etiology with an incidence of 0.9 cases per million. It typically affects the upper or lower limbs and can cause severe deformity and functional impairment. Diagnosis is radiological and is often described as a “flowing candle wax” appearance on the radiograph. Treatment is individualized depending on the site and severity of symptoms. We report a rare case of spinal melorheostosis. We demonstrate the imaging features of melorheostosis on CT and MRI. We discuss the classification, genetics, and management of this condition.
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Affiliation(s)
| | - James Langdon
- Department of Orthopaedics, Watford General Hospital, Watford, Hertfordshire, United Kingdom,
| | - Vivek Malhotra
- Department of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom
| | - Uday Mandalia
- Department of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom
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Hoang VT, Van HAT, Chansomphou V, Trinh CT. The dripping candle wax sign of melorheostosis. SAGE Open Med Case Rep 2020; 8:2050313X20940564. [PMID: 32922791 PMCID: PMC7446549 DOI: 10.1177/2050313x20940564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022] Open
Abstract
Melorheostosis is a rare benign bone disease including dysostosis and sclerosis. Dripping candle wax presence is a common and typical sign of melorheostosis. This sign appears as irregular hyperostosis of the cortical bone which is likened to melted wax flowing down one side of a candle. It can sometimes cause pain, stiffness joint, or limitation of motion in the affected areas implicitly but mostly has no symptoms. It is usually observed on plain radiography; its appearance is generally hyperplasia on one side of the bone. We report a 33-year-old male who has an incidental diagnosis of melorheostosis post-trauma.
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Affiliation(s)
- Van Trung Hoang
- Radiology Department, Thien Hanh Hospital, Buon Ma Thuot City, Vietnam
| | - Hoang Anh Thi Van
- Radiology Department, Thien Hanh Hospital, Buon Ma Thuot City, Vietnam
| | - Vichit Chansomphou
- Radiology Department, Savannakhet Medical-Diagnostic Center, Kaysone Phomvihane City, Lao People's Democratic Republic
| | - Cong Thao Trinh
- Radiology Department, Hue Central Hospital, Hue City, Vietnam
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Kumar S, Jain VK, Prabhakar R. Melorheostosis of upper limb: A report of four rare cases. J Clin Orthop Trauma 2020; 11:321-323. [PMID: 32099304 PMCID: PMC7026615 DOI: 10.1016/j.jcot.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 11/16/2022] Open
Abstract
Melorheostosis is a rare chronic bone disease, etiology of which remains unclear. It mostly affects lower limbs and clinical features vary in each case. Radiographs show characteristic "candle wax pattern" of hyperostosis. Herein we report four cases of upper limb affection with their symptoms, radiographic findings and treatment. First case presented with gradually progressive swelling in forearm which was initially misdiagnosed as filariasis. Plain radiograph eventually demonstrated melorheostosis of ulna. Second patient had deformity of index finger and pain in hand which was diagnosed on radiograph of hand. Third case presented with progressive flexion deformity of ring and little finger. Fourth patient had ulnar involvement which was an incidental diagnosis. First three patients were managed with bisphosphonates following which there was significant improvement in pain and fourth case was kept on follow-up as he was asymptomatic.
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Papadakis GZ, Jha S, Bhattacharyya T, Millo C, Tu TW, Bagci U, Marias K, Karantanas AH, Patronas NJ. 18F-NaF PET/CT in Extensive Melorheostosis of the Axial and Appendicular Skeleton With Soft-Tissue Involvement. Clin Nucl Med 2017; 42:537-539. [PMID: 28319505 DOI: 10.1097/rlu.0000000000001647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Melorheostosis is a rare, nonhereditary, benign, sclerotic bone dysplasia with no sex predilection, typically occurring in late childhood or early adulthood, which can lead to substantial functional morbidity, depending on the sites of involvement. We report on a patient with extensive melorheostosis in the axial and appendicular skeleton, as well as in the soft tissues, who was evaluated with whole-body F-NaF PET/CT scan. All melorheostotic lesions of the skeleton and of the ossified soft-tissue masses demonstrated intensely increased F-NaF activity, suggesting the application of this modality in assessing and monitoring the disease activity.
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Affiliation(s)
- Georgios Z Papadakis
- From the *Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD; †Foundation for Research and Technology Hellas, Institute of Computer Science, Computational Biomedicine Laboratory, Heraklion, Crete, Greece; ‡National Institute of Arthritis and Musculoskeletal and Skin Diseases and §PET Department, Clinical Center, National Institutes of Health, Bethesda, MD; ∥Center for Research in Computer Vision, Electrical and Computer Science Department, University of Central Florida, Orlando, FL; and ¶Department of Radiology, Medical School, University of Crete, Crete, Greece
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A Unique Case of Melorheostosis Presenting with Two Radiologically Distinct Lesions in the Shoulder. Case Rep Orthop 2017; 2017:9307259. [PMID: 29234550 PMCID: PMC5694994 DOI: 10.1155/2017/9307259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022] Open
Abstract
Melorheostosis is a rare, nonhereditary, benign, mesenchymal condition of unknown aetiology affecting the bones and surrounding tissues. A male patient complaining of left shoulder pain, swelling, and mildly limited range of motion has an exclusive combination of the classic dripping wax lesion in the scapula and the myositis ossificans-like lesion in the deltoid muscle; this combination is the first to be reported in the shoulder. Both lesions showed typical findings of melorheostosis in radiographs, CT, MRI, and bone scan. This case has a stationary course over the follow-up period, and no specific treatment is needed in due course.
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Chai T, Shroff GS. Pelvic Pain Due to Ischial Tuberosity and Acetabular Melorheostosis—Multimodal Image Presentation. PM R 2016; 8:917-8. [DOI: 10.1016/j.pmrj.2016.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/15/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas Chai
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 409, Houston, TX 77030
| | - Girish S. Shroff
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
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Ashish G, Shashikant J, Ajay P, Subhash D. Melorheostosis of the Foot: A Case Report of A rare entity with a Review of Multimodality Imaging Emphasizing the Importance of Conventional Radiography in Diagnosis. J Orthop Case Rep 2016; 6:79-81. [PMID: 27299136 PMCID: PMC4845422 DOI: 10.13107/jocr.2250-0685.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Melorheostosis is a benign bone dysplasia affecting predominantly the appendicular skeleton and adjoining soft tissues. The diagnosis can be established on plain radiographs alone and advanced imaging modalities can be avoided. We hereby report a rare case of melorheostosis affecting the foot with a review of the role of various imaging modalities in diagnosis of this rare bone dysplasia. Case Report: We present the case of a 29 years old man who was diagnosed with melorheostosis affecting his left foot. The patient presented to the outpatient department of our tertiary care referral hospital with complains of pain in the left ankle and foot with imaging and evaluation done at a primary center. The radiograph revealed an irregular, longitudinal extraosseous hyperostosis along the body of the calcaneum and the metacarpals which was consistent with the classical radiological description of melorheostosis. The CT, MRI and bone scan findings corroborated our primary diagnosis. Conclusion: The purpose of this case report is to review the features of this rare disorder affecting the foot, on multiple imaging modalities and emphasizing the role of conventional radiology in its diagnosis.
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Affiliation(s)
- Gulia Ashish
- Department of Orthopedic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra. India
| | - Juvekar Shashikant
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra. India
| | - Puri Ajay
- Department of Orthopedic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra. India
| | - Desai Subhash
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra. India
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Guler I, Aybay MN, Cengiz A, Eser G. Melorheostosis of the spine and ribs. Spine J 2015; 15:1901-2. [PMID: 25912499 DOI: 10.1016/j.spinee.2015.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 04/01/2015] [Accepted: 04/15/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Ibrahim Guler
- Department of Radiology, Selcuk University Faculty of Medicine, Konya 42075, Turkey
| | - Muhsin Nuh Aybay
- Department of Radiology, Konya Education and Research Hospital, Konya, Turkey
| | - Ali Cengiz
- Department of Radiology, Konya Education and Research Hospital, Konya, Turkey
| | - Gul Eser
- Department of Radiology, Konya Education and Research Hospital, Konya, Turkey
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Arthroscopic findings in melorheostosis. J Clin Rheumatol 2015; 21:160-3. [PMID: 25807097 DOI: 10.1097/rhu.0000000000000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Melorheostosis is a rare dysplastic bone formation disease that can also affect the joints. We present a case of a patient with knee pain that was radiographically diagnosed as melorheostosis because of "dripping wax" image. An exploratory arthroscopy was made. In the joint, we found hyperplasic synovial tissue and an increased retropatellar Hoffa pad, which was surrounding an intra-articular ossification resulting from the disease. This was removed and led to a clinical and functional improvement.
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Vyskocil V, Koudela K, Pavelka T, Stajdlova K, Suchy D. Incidentally diagnosed melorheostosis of upper limb: case report. BMC Musculoskelet Disord 2015; 16:2. [PMID: 25637225 PMCID: PMC4320463 DOI: 10.1186/s12891-015-0455-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background Melorheostosis is quite a rare bone disease with still unclear ethiology. Although multifocal affection is highly debilitating with unfavorable prognosis, there is no clear consensus about therapeutical approach. There is still insufficient evidence in the literature for almost a century after the first description. Affected bone has a typical appearance of melting wax. Diagnosis is usually incidental with pain as a leading symptom. Diagnosis itself is relatively easy, routine X-ray examination is sufficient. Even though it could be easily overlooked and mistaken with other diseases. Melorheostosis is incurable, the therapy is mostly focused on maintaining patient quality of life. Presented case is unique in terms of extent of the affection (index finger, metacarp shaft, carpal bones, forearm, humerus and whole scapula) in combination with osteopoikilotic islands in other 3 regions (vertebrae, manubrium sterni and left collar bone). Currently there is only one such a case published in the literature (Campbell), but without osteopoikilotic islands. Case presentation Melorheostosis was diagnosed in 26-year old female after injury as an incidental finding. This was quite surprising as the patient already suffered by limited movement in the upper limb and pain before the injury. Detailed examination were performed to confirm the diagnosis, no family history was found. Pharmacotherapy with bisphosphonates, non-steroidal antirheumatics and vasodilatans/rheologic drugs seemed to be effective to maintain the relatively good quality of patient life and good performance in daily routine. Questionable is further development of patient performance status and sustainability of conservative treatment in the long term follow up. Conclusion Conservative treatment with bisphopshonates and COX-2 inhibitors in combination with naftidrofuryl can delay surgery solution.
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Affiliation(s)
- Vaclav Vyskocil
- Department of Orthopaedic Surgery, Faculty Hospital Plzen, Alej Svobody 80, Plzen, 304 60, Czech Republic.
| | - Karel Koudela
- Department of Orthopaedic Surgery, Faculty Hospital Plzen, Alej Svobody 80, Plzen, 304 60, Czech Republic.
| | - Tomas Pavelka
- Department of Orthopaedic Surgery, Faculty Hospital Plzen, Alej Svobody 80, Plzen, 304 60, Czech Republic.
| | - Kristyna Stajdlova
- Department of Imaging Methods, Charles University Teaching Hospital Plzen and Medical Faculty Plzen, Alej Svobody 80, Plzen, 304 60, Czech Republic.
| | - David Suchy
- Department of Clinical Pharmacology, Charles University Teaching Hospital E. Benese 13, Plzen, 30599, Czech Republic.
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Abstract
Focal lesions in bone are very common and many of these lesions are not bone tumors. These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes. Many of these tumor mimickers can be left alone, while others can be due to a significant disease process. It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup. Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety.
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Affiliation(s)
- Jennifer Ni Mhuircheartaigh
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Yu-Ching Lin
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States ; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung Chang Gung University, Taoyuan, Taiwan
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
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Anderson K, Shintaku W, Rosebush M, Rawal Y, Woodard E. Melorheostosis and central giant cell granuloma of the mandible in a 15-year-old girl. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e399-404. [DOI: 10.1016/j.oooo.2013.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/22/2013] [Accepted: 07/29/2013] [Indexed: 11/27/2022]
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Osher LS, Blazer MM, Bumpus K. Appearance of osteolysis with melorheostosis: redefining the disease or a new disorder? A novel case report with multimodality imaging. J Foot Ankle Surg 2013; 52:602-11. [PMID: 23680113 DOI: 10.1053/j.jfas.2013.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Indexed: 02/03/2023]
Abstract
We present a case report of melorheostosis with the novel radiographic finding of underlying cortical resorption. A number of radiographic patterns of melorheostosis have been described; however, the combination of new bone formation and resorption of the original cortex appears unique. Although the presence of underlying lysis has been postulated in published studies, direct radiographic evidence of bony resorption in melorheostosis has not been reported. These findings can be subtle and might go unnoticed using standard imaging. An in-depth review of the radiographic features is presented, including multimodality imaging with magnetic resonance imaging and computed tomography.
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Affiliation(s)
- Lawrence S Osher
- Kent State University College of Podiatric Medicine, Independence, OH 44131, USA.
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Zhang C, Dai W, Yang Y, Tang Q, Yao Z. Melorheostosis and a review of the literature in China. Intractable Rare Dis Res 2013; 2:51-54. [PMID: 25343102 PMCID: PMC4204579 DOI: 10.5582/irdr.2013.v2.2.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/24/2013] [Indexed: 01/15/2023] Open
Abstract
Melorheostosis is an uncommon, non-genetic, non-developmental, sclerosing dysplasia of bone and adjacent soft tissues, with deformity of the extremity, pain, limb stiffness and limitation of motion. The characteristic radiographic appearance consists of irregular hyperostotic changes of the cortex resembling melted wax dripping down the side of a candle. In this review, clinical characteristics of Melorheostosis are discussed and reports in the Chinese literature are summarized.
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Affiliation(s)
- Chi Zhang
- Orthopaedic Department, Zhongshan hospital, Fudan University, Shanghai, China
| | - Wenda Dai
- Orthopaedic Department, Zhongshan hospital, Fudan University, Shanghai, China
| | - Yi Yang
- Orthopaedic Department, Zhongshan hospital, Fudan University, Shanghai, China
| | - Qi Tang
- Department of Health Care Management and Maternal and Child Health, Shandong University, Ji'nan, Shandong, China
| | - Zhenjun Yao
- Orthopaedic Department, Zhongshan hospital, Fudan University, Shanghai, China
- Address correspondence to: Dr. Zhenjun Yao, Orthopaedic department, Zhongshan hospital, Fudan University, Shanghai 200032, China. E-mail:
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Chou SH, Chen CH, Chen JC, Chien SH, Cheng YM. Surgical treatment of melorheostosis: report of two cases. Kaohsiung J Med Sci 2012; 28:285-8. [PMID: 22531309 DOI: 10.1016/j.kjms.2011.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 03/15/2011] [Indexed: 10/28/2022] Open
Abstract
Melorheostosis is a rare disease that usually burdens the patient with painful disability or soft tissue compromise. The treatment is usually symptomatic and conservative. Patients with severe and complicated forms of the disease may require surgery. Involvement of the distal part of a limb usually carries more morbidity, such as tumefaction pain, cosmetic and psychosocial or functional problems that render conservative treatment unsatisfactory to patients. In our series, surgical debulking or decompression of the mass effect provided prompt symptom relief.
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Affiliation(s)
- Shih-Hsiang Chou
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Hassani H, Slama J, Hayem G, Ben Ali K, Sarda-Mantel L, Burg S, Le Guludec D. Melorheostosis associated with peripheral form spondyloarthropathy: new image with 18-fluoride positron emission tomoscintigraphy coupled to computed tomography. Open Access Rheumatol 2012; 4:1-7. [PMID: 27790007 PMCID: PMC5045094 DOI: 10.2147/oarrr.s28657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Melorheostosis is a rare benign bone pathology which can be responsible for incapacitating pain and bone deformations. Its imaging abnormalities are often typical. We describe here the case of a patient with melorheostosis involving the lower limbs, associated with a peripheral form of inflammatory spondyloarthropathy, who underwent 18FNa positron emission tomography coupled to a computed tomography scan. Our objective is to present this new image, to show the value of this new modality and emphasize its advantages compared to the 99mTechnetium bone scan.
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Affiliation(s)
- Hakim Hassani
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France; Radiology, Hôpital Robert Debré, Paris, France; University Paris VII Denis Diderot, Paris, France
| | - Jérôme Slama
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France; University Paris VII Denis Diderot, Paris, France
| | | | - Khadija Ben Ali
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France
| | - Laure Sarda-Mantel
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France; University Paris VII Denis Diderot, Paris, France
| | - Samuel Burg
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France; University Paris VII Denis Diderot, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France; University Paris VII Denis Diderot, Paris, France
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Salman Monte TC, Rotés Sala D, Blanch Rubió J, Bittermann V, Carbonell Abelló J. [Melorheostosis, a case report]. ACTA ACUST UNITED AC 2011; 7:346-8. [PMID: 21925454 DOI: 10.1016/j.reuma.2010.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 10/28/2010] [Accepted: 11/17/2010] [Indexed: 11/28/2022]
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