case_images: PMC11788400_01
case_images: X-ray images of the left femur after removal of osteosynthetic materials: the frontal coronal plane image revealed a variety of radiolucent lesions in the diaphysis, with sclerotic edges, scalloping and a "ground-glass" appearance (a) sagittal plain radiographs showed an increased sagittal radius of curvature and retrotorsion of the proximal femur (b).
case_images: fped-12-1505766-g001.jpg
case_images: PMC11788400_01_fped-12-1505766-g001.jpg
case_images: F1
case_images: X-ray images of the left femur revealed various radiolucent lesions in the diaphysis, with sclerotic edges, scalloping and a ground-glass appearance (Figure 1a). The patient's plain radiographs showed no coxa vara or shepherd's crook deformities but revealed an increased sagittal radius of curvature and retrotorsion of the proximal femur (Figure 1b).
case_images: Selected total-body MRI at the level of the pelvis and both femurs using low signal intensity on T1-weighted images and demonstrating the foci of FD affecting the epiphysis, the femoral neck, the diaphyseal regions of the left femur and the same hip's acetabulum. A lesion is visible in the subtrochanteric region of the right femur (a). There was a high signal intensity without diffusion restriction on the fat-suppressed T2-weighted images enhanced with gadolinium (b).
case_images: fped-12-1505766-g002.jpg
case_images: PMC11788400_01_fped-12-1505766-g002.jpg
case_images: F2
case_images: Whole body MRI confirmed the diagnosis of polyostotic FD, displaying FD foci in the left femur, right tibia, left fibula, left calcaneus, both iliac wings, maxillary bone, and the sphenoid wing (Figure 2). T1-weighted images (Figure 3a) and a high signal intensity in fat-suppressed T2-weighted images, also showing strong gadolinium enhancement (Figure 3b) without diffusion restriction (Figure 2b). There was no significant bone marrow or soft tissue enhancement.
case_images: MRI focusing on left proximal femur lesions: the focus of the FD of the proximal epiphysis and the significant involvement of the femoral neck can be seen precisely. The examination did not demonstrate transphyseal diffusion of the FD, and the lesions seemed not to originate from the epiphyseal growth plate. All the lesions were characterised by a low signal intensity on T1-weighted images (a), but these were significantly better in the T1-weighted images enhanced with gadolinium (b).
case_images: fped-12-1505766-g003.jpg
case_images: PMC11788400_01_fped-12-1505766-g003.jpg
case_images: F3
case_images: T1-weighted images (Figure 3a) and a high signal intensity in fat-suppressed T2-weighted images, also showing strong gadolinium enhancement (Figure 3b) without diffusion restriction (Figure 2b). There was no significant bone marrow or soft tissue enhancement.
case_images: Scintigraphy confirmed polyostotic hyperfixation and demonstrated an unknown parasymphyseal involvement of the mandible with extension into its right branch.
case_images: fped-12-1505766-g004.jpg
case_images: PMC11788400_01_fped-12-1505766-g004.jpg
case_images: F4
case_images: Scintigraphy, added to assess skull involvement, confirmed the polyostotic hyperfixation and demonstrated an unknown parasymphyseal involvement of the mandible with an extension into its right branch (Figure 4).