Tackling Trevor: A Case Review of Trevor’s Disease

Purpose or Learning Objective: This educational poster reviews a patient with a rare case of Trevor’s disease (hemimelic epiphyseal dysplasia) who presented to our department, along with a review of the disease and imaging findings.

Methods or Background: Trevor’s disease is a rare nonhereditary disorder of skeletal development characterized by one-half epiphyseal involvement, producing an osteocartilaginous outgrowth associated with the presence of accessory epiphyseal ossification centers. Often misdiagnosed as infection, traumatic injuries, or tumors, there is a male predilection with an age range from 2 to 14 years. The literature describes no cases of malignant degeneration. Most patients have no pain and present with deformity and limitation of motion of the affected joint. Plain radiographs are diagnostic, initially showing an irregular calciferous mass arising from one side of the joint. Multiple ossification centers appear at one side of the epiphysis. Later on, these ossification centers become confluent with the underlying bone.

In the early stages, identification by radiography may be difficult because the lesion can be mistaken for a tumor. Computed tomography demonstrates the relationship between bones, soft tissues, and the cartilaginous mass. Magnetic resonance imaging (MRI) aids in determining the extent of epiphyseal involvement, joint deformity, and soft tissue changes. Some authors recommend whole-body MRI for detecting additional lesions. Imaging diagnosis is usually straightforward.

Differentials include osteochondroma, metachondromatosis, synovial osteochondromatosis, parosteal osteosarcoma, and chondroblastoma. Biopsy is not necessary but may be useful early on when the radiographic changes are not yet typical or when masses are in unusual locations. Resection is generally favored to prevent deformities, degenerative arthritis, and limb-length discrepancies. Regular follow-up is needed until skeletal maturity. Prognosis depends on lesion location and size. Recurrence is possible until epiphyseal closure occurs.

Results or Findings: An 18-month-old male patient presented with left knee valgus and discomfort. Plain radiographs showed a partially calcified exophytic focus in the medial distal femoral epiphysis. MRI showed irregular decreased signal intensity epiphyseal foci on all sequences with blooming artifact involving half of the epiphysis. With review of the previous knee radiographs, the typical appearance of Trevor’s disease was noted.

Conclusion: This case study highlights the features of Trevor’s disease that radiologists should consider when encountering an epiphyseal lesion.

 

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Artikel online veröffentlicht:
22. Mai 2024