Case contributed by Dr Antonio Rodrigues de Aguiar Neto


This patient was admitted to the ER victim of a motorcycle-truck collision, with pain and deformity in his right wrist and pain in his right knee, in addition to dyspnea and closed abdominal trauma.

Patient Data

Age: 30 years
Gender: Male

CT images demonstrate numerous scattered well-defined, homogeneous, small round and ovoid sclerotic bony foci throughout the axial and the appendicular skeleton. These lesions are in the skull's bones, the face, the vertebrae, the ribs, the pelvis, and around the glenohumeral and hip joints. These radiodense foci represent bone islands (enostoses), consistent with the diagnosis of osteopoikilosis. 

All bones are free of any cortical erosion or periosteal reaction., without Any fractures or soft tissue component. 

Impression: These are diagnostic findings of osteopoikilosis. 

Chest CT shows volumetric reduction and parenchymal opacities in both lower lobes lungs, with findings representing atelectasis, which may be overlap with pulmonary contusion areas. Such changes can infect and evolve with pneumonia. Tracheostomy cannula.

Case Discussion

Osteopoikilosis is an autosomal dominant benign sclerosing bony dysplasia, typically found incidentally on imaging studies done for other orthopedic reasons 1-4. The radiographic and CT features are multiple benign enostoses 1-4.  Its importance is predominantly to recognize this condition so that it is not mistaken for pathology and prevent unnecessary emotional distress and invasive testing 2,4.

 This case demonstrates an atypical presentation of osteopoikilosis diagnosed incidentally, with involvement of the skull and spine.

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