Each of the following radiographs were obtained for different indications.
What is the glaring abnormality?
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Note there is diffuse homogeneous sclerosis involving only the axial skeleton and not the distal extremities.
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:
- Normal creatinine excluded renal osteodystrophy.
- No osteosclerosis of distal appendicular skeleton and so excludes osteopetrosis.
- 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.
- 1. Delcambre B, Flipo R, Leroux J et-al. Skeletal Radiology. 1989;18 (1): . doi:10.1007/BF00366765
- 2. Heursen EM, González Partida Mdel C, Paz Expósito J et-al. Osteomesopyknosis-a benign axial hyperostosis that can mimic metastatic disease. Skeletal Radiol. 2016;45 (1): 141-6. doi:10.1007/s00256-015-2216-3 - Pubmed citation
- 3. Maroteaux P. Osteomesopycnosis. A new autosomal dominant osteosclerosing bone disease (author's transl). Arch. Fr. Pediatr. 1981;37 (3): 153-7. Pubmed citation