Answer for BIR CoW 16 Aug 2020
Paget Disease
Findings
AP and Lateral radiograph of left femur shows a well defined lytic lesion in the diaphysis with a blade of grass appearance. MR images show preserved marrow fat, thickened cortex with prominent trabeculae.
Discussion
Paget disease is characterized by increased and disordered bone turnover and remodeling, predominantly affecting elderly population. It commonly affects skull, spine, pelvis and proximal long bones. It can be monostotic or polyostotic. The imaging appearance of Paget disease depends on the stage of disease. Typically there are three stages as follows: 1. Stage 1- lytic phase – osteoclasts predominate- lytic, thinned cortex 2. Stage 2- mixed phase –osteoblasts repair and bone resorption-mixed lytic and sclerotic lesions 3. Stage 3- blastic phase- osteoblasts predominate- sclerotic lesions and cortical thickening Computed tomography and Magnetic Resonance imaging shows thickened cortex, prominent trabaculae and preserved marrow fat of the affected bones thus helps in differentiating it from neoplastic process. Complications include deformity, fracture, arthritis, neurologic symptoms, and sarcomatous transformation.
Findings
AP and Lateral radiograph of left femur shows a well defined lytic lesion in the diaphysis with a blade of grass appearance. MR images show preserved marrow fat, thickened cortex with prominent trabeculae.
Discussion
Paget disease is characterized by increased and disordered bone turnover and remodeling, predominantly affecting elderly population. It commonly affects skull, spine, pelvis and proximal long bones. It can be monostotic or polyostotic. The imaging appearance of Paget disease depends on the stage of disease. Typically there are three stages as follows: 1. Stage 1- lytic phase – osteoclasts predominate- lytic, thinned cortex 2. Stage 2- mixed phase –osteoblasts repair and bone resorption-mixed lytic and sclerotic lesions 3. Stage 3- blastic phase- osteoblasts predominate- sclerotic lesions and cortical thickening Computed tomography and Magnetic Resonance imaging shows thickened cortex, prominent trabaculae and preserved marrow fat of the affected bones thus helps in differentiating it from neoplastic process. Complications include deformity, fracture, arthritis, neurologic symptoms, and sarcomatous transformation.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!