Learning Radiology xray montage

Leri’s Disease, Flowing Periosteal Hyperostosis

General Considerations

  • One of a group of sclerosing bone disorders
  • Rare
  • Cause is unknown
  • Produces thickening of the endosteum and periosteum
  • Peak age of presentation is 5-20 years
  • May be monostotic or polyostotic
    • May involve one entire limb
      • Usually does not involve multiple limbs
  • Twice as common in lower extremities than elsewhere

Clinical Findings

  • About 50% affected develop symptoms by age 20
  • Adults present with
    • Pain
    • Joint stiffness
    • Deformity that may progress over time
  • Children may present with
    • Leg length discrepancies
    • Joint contractures

Imaging Findings

  • Patterns described include:
    • Resembling osteoma(s)
    • Candle-wax appearance (classic)
    • Resembling myositis ossificans
    • Resembling osteopathia striata
    • Mixed
  • Sclerotic lesions of cortical bones, usually in the diaphysis, that resemble “candle-wax-dripping”
  • Cortical hyperostosis with an undulating appearance usually affecting one side of a bone
  • Soft tissue lesions that may calcify
    • Adjacent to involved bone
  • May grow to compress nerves
  • Usually low signal on MRI
    • Enhance with Gadolinium
  • Bone scan is markedly positive

Differential Diagnosis

  • Osteopathia striata
    • Longitudinal dense striations
  • Osteopoikilosis
    • Punctate, rounded bone islands surrounding joints
  • Osteosarcoma
    • Bone destruction


  • Analgesia
  • Nerve blocks
  • Surgery directed at relieving contracture


  • Associated soft tissue lesions and cutaneous lesions
    • Vascular malformations
    • Neurofibromatosis
    • Tuberous sclerosis
    • Hemangioma
  • Muscle contractures
  • Scoliosis


  • Progressive disorder

Melorheostosis. Frontal and oblique radiographs of the hand shown in close-up demonstrate the undulating cortical hyperostosis representing the classical "candle-wax" dripping appearance
involving only the radial side of the 3rd metacarpal shaft.
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BoneTumor.org  DeGroot, H.