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lower extremity and particularly about the medial one half of the left lower extremity, deformity is present. On the radiograph, there is bony overgrowth along the medial aspect of the knee and ankle that extends to involve the joints. The left lower extremity is shorter than the right. The MRI and CT studies demonstrate cartilage and bony overgrowth along the medial aspects of the knee and ankle. Bony bridging is present of the ankle articulation.
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OfFindingstheleft
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The patients can present with pain, deformity, swelling, or mechanical issues. As seen in this case there is often a limb discrepancy and rotational deformities. Surgical intervention with resection of the abnormal cartilage/bony proliferation and then osteotomy to correct the limb deformity is often performed.
Trevor’s disease or dysplasia ephiphysealis hemimelica (DEH) is a rare skeletal dysplasia. Originally thought to represent osteochondroma occurring at the end of the bone, it has now been shown to be a distinct entity from osteochondroma. It is now more so thought to represent an abnormal proliferation of the epiphyseal cartilage at the end of the bone which can ossify and then subsequently fuse across the joint. In more advanced cases, the cartilage of the physis can also hypertrophy and can extend into the metaphysis. As shown in this case, only one half of the affected limb is involved and hence the term hemimelica.
Diagnosis: Trevor’s Disease
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MoreReferencesThanEpiphyseal
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Osteochondromas: Updated Understanding of Imaging Findings in Dysplasia Epiphysealis Hemimelica (Trevor Disease). Andrew J. Degnan, Victor M. Ho-Fung. American Journal of Roentgenology. 2018;211: 910-919. 10.2214/AJR.18.19712.