Osteomesopyknosis

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Each of the following radiographs were obtained for different indications.

Patient Data

Age: 45 years old
Gender: Male

What is the glaring abnormality?

Modality: X-ray

Note there is diffuse homogeneous sclerosis involving only the axial skeleton and not the distal extremities.

Case Discussion

Incidental stable diffuse sclerosis of axial skeleton for several years in a patient with normal labs.

The most crucial observation is that there is no sclerosis of distal appendicular skeleton. It is important to remember and diagnose this condition in the differential diagnosis of diffuse bony sclerosis, so we do not order more radiologic studies or give a malignant differential.

I was reading this chest radiograph and we had been mentioning stable diffuse sclerotic changes of the thoracic bones. At which time I consulted Dr. Clarence Joe who is the musculoskeletal radiologist in Augusta University.

This is how we made the diagnosis here:

  1. Normal creatinine excluded renal osteodystrophy.
  2. No osteosclerosis of distal appendicular skeleton and so excludes osteopetrosis.
  3. Normal calcium levels and alkaline phosphatase levels excludes Paget's disease and any disease with rapid bone turnover.

Then we researched online what disease this could be and the best diagnosis causing an incidental and stable osteosclerosis of just axial skeleton in literature was osteomesopyknosis as shown in other references below.

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Case Information

rID: 43696
Case created: 21st Mar 2016
Last edited: 9th Aug 2016
Inclusion in quiz mode: Included

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