Blade of grass sign in Paget disease

Case contributed by Ivan Turkalj


An elderly female complaining of leg pain. Serum alkaline phosphatase is markedly elevated.

Patient Data

Age: 75 years
Gender: Female

A well defined, wedge shaped lytic lesion in the right femoral diaphysis is seen, with no evidence of periosteal reaction or cortical disruption.

Case Discussion

Findings are consistent with osteolytic phase of Paget disease. 

The blade of grass or the flame sign is a wedge- or V-shaped radiolucency typically located in the diaphysis of long bones such as femur or tibia.

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