Figure 1

clinical synopsis of a 6 years old girl with a history of short stature. Figure 1a shows the patient at the time of suspected growth hormone releasing hormone failure. 2 months after growth hormone therapy started a painful swelling of the cheek was noted (figure 1c) which worsened at the time of presentation 3 months later (figure 1d). Initial magnetic resonance imaging (MRI) was normal (figure 1b: T2-weighted transversal image (slice thickness 5 mm)). Subsequent MRI 5 months later did show a diffuse bone lesion affecting the os zygomaticum and involving surrounding soft tissue (figure 1e: Fat saturated strongly T2-weighted transversal image (slice thickness 5 mm)). Malignancy could not be excluded. Computed tomography revealed hyperostosis in addition to osteolysis (arrows) of the cortical bone (figure 1f). Conventional x-ray of the right hemithorax showed hyperostosis of the anterior 4^th rip (figure 1g). Technetium 99m-MDP bone scan showed the involvement of the os zygomaticum and the clinically silent costal lesion (figure 1h). 1 year of non-steroidal anti-inflammatory treatment induced clinical remission (figure 1i). MRI did show a very small signal elevation in the area of the biopsy (figure j: Fat saturated strongly T2-weighted transversal image (slice thickness 5 mm)).