Preliminary CT scan showed extensive cortical thickening and periosteal reaction
along the ulnar side of the second metacarpal (Figure 3).
The lesion may have spiculated periosteal reaction
. In rare cases, medullary hemangiomas may appear completely lucent on radiographs as in our case.
Histological appearance was characterised by a nearly circumferential periosteal reaction
, reactive new bone formation, occasional sequester formation, and drastic infiltration of polymorphonuclear leukocytes with occasional microabscesses.
X-ray demonstrates good fixation of implant without loosening, some eccentric wear on the right polyethylene liner, no periosteal reaction
. There is bilateral Brooker III/IV heterotopic ossification.
It is difficult to differentiate SAPHO syndrome from suppurative osteomyelitis because of its nonspecific findings, such as bone marrow edema and periosteal reaction
. Suei et al.
Characteristics of benign lesions include well-defined or sclerotic borders, sharp transitions zones, and lack of a periosteal reaction
. More aggressive lesions will show poor defnition, bony destruction, periosteal reaction
, and sometimes a soft tissue component.
 Chronic stress leads to periosteal reaction
and cortical thickening at the injury site, which make the fracture visible on the plain radiographs over time.
Four weeks later, he developed extensive lytic lesion of proximal femur metaphysis with onion skin periosteal reaction
in diaphysis in spite of intravenous antibiotics.
The right foot shows moderate soft tissue swelling surrounding the distal tarsometatarsus and digits with a periosteal reaction
. Joint spaces are unremarkable.
There was also a periosteal reaction
in the control group accompanying the newly formed bone which represented the continuation of the healing process.
Magnetic resonance imaging (MRI) is very sensitive and can show bone edema, soft tissue inflammationand bony changes such as periosteal reaction
, hyperostosis, growth plate damage, or fracture [12-15].