A case of congenital hemihypertrophy showing variations in bone age and development.

Although the ancient Greek and Roman sculptors recognized that the human frame was not symmetrical, it was not until 1822 that Meckel pointed out variations in size and shape of the two halves of the body, and the first clinical report of a patient with hemihypertrophy was made by Wagner in 1839. Since that day there have been only just over 100 cases reported throughout the world claiming total hemihypertrophy, and this is probably in excess of the truth if the name given to the condition is taken literally. Ward and Lerner (1947), in reviewing the case reports, state that necropsies had been recorded in only seven cases, and they added a case report of their own with necropsy findings, and concluded, according to their classification of hypertrophy, that their patient had congenital total hemihypertrophy. It is doubtful, however, if this claim can be accepted, as one set of paired organs, namely, the kidneys, was equal in size, and the two lobes of the thyroid were also apparently equal. In the absence of a necropsy, the diagnosis of congenital total hemihypertrophy has to be made on external appearances, with the assumption that the internal paired organs will also show hypertrophy on the affected side. That this assumption may be false is shown by the case quoted above, and also by the necropsy findings of the case recorded in this paper. The chief interest in this case, however, lies in the radiological appearances of the wrists and hands, which show well marked differences in the extent of ossification of the carpal nuclei on the two sides, and also structural abnormality of the bones themelves.