case_images: PMC11151411_01
case_images: Anterior-posterior (AP) radiograph of the pelvis (a) demonstrates mixed lytic, sclerotic, expansile lesions (white arrow) with associated varus angulation and bowing, and shepherd crook deformity of the proximal femur (black arrow). AP radiograph of the knees (b) shows a similar lesion within the left proximal tibia (black arrow) with a soft tissue mass adjacent to the left medial distal femur (white arrow).
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case_images: PMC11151411_01_SAJR-28-2877-g001.jpg
case_images: F0001
case_images: Radiographs of the pelvis (Figure 1a) demonstrated expansile, mixed lytic and sclerotic lesions of both proximal femora with an associated shepherd crook deformity of the right femur and cranial migration of the left femur. Radiographs of the knees (Figure 1b) showed a mixed lytic-sclerotic lesion of the left proximal tibia with an impression of a soft tissue mass adjacent to the medial distal femur.
case_images: Axial T2-weighted images (a) of the left thigh confirm the intramuscular myxomas, which are T2 hyperintense with internal septations. Coronal T1 pre- and post-gadolinium images (b, c) demonstrate hypointense myxomas with heterogenous peripheral and patchy internal enhancement. The lesions are within the vastus medialis muscle.
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case_images: PMC11151411_01_SAJR-28-2877-g002.jpg
case_images: F0002
case_images: T1-weighted imaging (T1WI) (Figure 2b) with inhomogeneous contrast enhancement (Figure 2c). The MRI findings suggested a benign lesion characterised by the lack of intense contrast enhancement together with a more homogenous T1-weighted appearance and no intralesional fat, as seen in myxoid liposarcoma. The presence of higher apparent diffusion coefficient values is useful in distinguishing myxoma from myxoid liposarcoma with values less than 2.06 x 10-3 mm2/s supporting the latter.
case_images: Coronal T1 post-gadolinium image of the pelvis confirms multifocal, enhancing, intra-osseous lesions within the left ilium (white arrow), right ilium, sacrum and proximal femora.
case_images: SAJR-28-2877-g003.jpg
case_images: PMC11151411_01_SAJR-28-2877-g003.jpg
case_images: F0003
case_images: The pelvic MRI (Figure 3) demonstrated expansile, enhancing lesions within the left iliac wing and the proximal femora bilaterally.
case_images: PMC11151411_02
case_images: Anterior-posterior (AP) radiograph of the skull (a) demonstrates a unilateral, expansile sclerotic lesion of the spheno-temporal bone (black arrow). AP radiograph of the pelvis and proximal femora (b) demonstrate an expansile, mixed, lytic-sclerotic lesion of the right proximal femur (white arrow) with endosteal scalloping.
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case_images: PMC11151411_02_SAJR-28-2877-g004.jpg
case_images: F0004
case_images: Radiographs demonstrated features of polyostotic FD with an expansile and predominantly sclerotic lesion in the right sphenoid bone (Figure 4a). The right femur demonstrated mixed lytic-sclerotic changes with a shepherd crook deformity (Figure 4b).
case_images: Coronal T2-weighted MRI images (a, b) confirm focal unilateral involvement of the spheno-temporal bone with homogenous hypointensity (white arrows). Associated extension into the pituitary fossa is demonstrated with minimal cranial displacement of the hypothalamic-pituitary axis. The hypothalamic-pituitary axis was otherwise normal.
case_images: SAJR-28-2877-g005.jpg
case_images: PMC11151411_02_SAJR-28-2877-g005.jpg
case_images: F0005
case_images: The MRI revealed expansion of the right sphenoid and temporal bones (Figure 5a and b) with low-intensity signal on all sequences in keeping with the sclerosis noticed on plain radiographs.