INCIDENTAL AXIAL MELORHEOSTOSIS OF THE THORACIC VERTEBRA AND RIB IN AN ASYMPTOMATIC ELDERLY PATIENT: A MULTIMODALITY IMAGING CASE REPORT

Abstract

Melorheostosis is a rare benign sclerosing bone dysplasia typically affecting the appendicular skeleton in a sclerotomal distribution. Axial involvement is extremely unusual, with only a few dozen reported cases involving the spine or ribs. We present an 80-year-old asymptomatic male who underwent computed tomography (CT) of the chest for evaluation of unrelated respiratory symptoms. Incidentally noted was dense unilateral flowing cortical hyperostosis involving the right posterolateral aspect of the D3 vertebral body, extending into the posterior elements and adjacent third rib. Subsequent plain radiography confirmed the characteristic "dripping candle-wax" appearance, while magnetic resonance imaging demonstrated uniformly hypointense signal on all sequences without marrow edema or soft tissue component, consistent with melorheostosis. Given the absence of symptoms and lack of aggressive imaging features, conservative management with clinical observation was recommended. This case highlights the characteristic multimodality imaging features of axial melorheostosis, emphasizing the importance of recognizing this benign entity to prevent misdiagnosis as malignancy and avoid unnecessary invasive procedures. To our knowledge, combined vertebral and rib involvement detected incidentally in an asymptomatic elderly patient is rarely reported.