“Dripping wax” appearance

Case contribution: Dr. Radhiana Hassan

Clinical:

• A 30 years old female
• Painful swelling at little finger for 10 years.
• No history of trauma
• No fever or constitutional symptoms

X-Ray findings:

• Dense continuous cortical thickening involving the 4th and 5th metacarpals and phalanges (yellow arrows)
• Thick undulating edges giving rise to ‘dripping wax’ appearance
• No fracture of visualized bones.
• No joint space narrowing
• Carpals bones are normal

Diagnosis: Melorheostosis

Discussion:

• Melorheostosis is a rare chronic bone disorder
• It manifests as region of sclerosing bone with characteristic appearance known as dripping wax appearance or flowing candle wax appearance
• It can be either monostotic or polyostotic and tends to be monomelic
• It usually affects long bones of the limbs, but any bones can be affected
• Hands and feets are not infrequently involved
• Involvement of the axial skeleton is rare.
• THis condition has tendency to involve a sclerotome distribution
• Associated changes that can be seen include thickening and fibrosis of underlying skin, hyperpigemntation of overlying skin, muscle atrophy, vascular tumours and malformation, other tumours