Reossification in Gorham's disease of the hand and wrist with unusual CT and MR imaging features

Gorham's disease (GD) rarely occurs in the hand and wrist. Only nine cases of GD in the hand and wrist have been reported in the literature. The imaging technique used in all nine cases was mainly radiography. The natural history of GD is unpredictable. Spontaneous regression has been reported in a few cases. There is no consensus about the most efficient treatment of GD. Surgical resection and reconstruction with bone grafts and/or prostheses are used sparingly as bone grafts tend to be resorbed in most cases. We report a case of GD that involved the right hand and wrist in a 26-year-old male. The lesion displayed multiple areas of osteolysis in the metacarpals, carpals and proximal phalanx of the base of the thumb on radiography, while on CT and MRI, the osteolytic areas showed homogeneous density and signal intensity, similar to that of fluid. The patient was successfully treated by surgical reconstruction with autogenous iliac bone grafts. Gradual reossification in the osteolytic areas had occurred by the 3-year follow-up evaluation. This case merits special attention because of the unusual location of the involvement, unusual CT and MR imaging findings and unusual reossification in the osteolytic areas.