Case of the Month April 2016

Multiple Hereditary Exostosis

Submitted by Yaniv Raphael, MD, and approved by Thomas J. Learch, MD.

SM is a 44-year-old female without significant past medical history who initially presented to her primary care physician with complaint of enlarging left lateral buttock mass. The pain had increasingly become intractable, leading to disturbances in sleep and daily activities. Otherwise, patient denied any constitutional symptoms. Physical examination was pertinent for a firm nonmobile mass adherent to the left ilium without associated tenderness to palpation or fluctuance. Laboratory data was within normal limits. Imaging work-up included a frontal radiograph of the hips, which revealed multiple sessile exostoses involving the pelvic bones (Figure 1). Symmetric coxa valga deformities and osseous expansion of the pubic ramii further suggested osteochondromatosis. An irregular pedunculated exostosis arising from the left superior iliac crest was also noted.

Figure 1: Frontal radiograph of the pelvis demonstrates innumerable sessile exostoses and bilateral coxa valga deformity. Osseous bridging of the pubic symphysis is also identified in addition to an irregular pedunculated exostosis arising from the left superior iliac crest, presumably the cause of patient’s symptoms. The sacoiliac joints are congruent. Non-obstructive bowel gas pattern is also seen.

For a larger image, please click on Exostosis 1 .

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