Paget disease

Case contributed by Dr Ian Bickle

Presentation

Right flank pain. Renal stones?

Patient Data

Age: 75 years
Gender: Male
X-ray

No renal tract stones.

Coarse and thickened trabeculae with minor bony expansion involving the right pubic rami and pubic symphysis. In addition, there is a thickening of the right iliopectineal line also known as pelvic brim sign.

Pelvic brim sign

Annotated image

The annotated images demonstrate the pelvic brim sign.

Case Discussion

Typical appearances and site for Paget disease of the bone with the pelvic brim sign. It is frequently an incidental finding. 

With all radiographs:

  • assess the whole film, even the bits not related to the clinical query
  • satisfaction of search is called so for a reason
  • you never know when your report might help; for example, in this case, five years later when a bone scan is undertaken for prostate carcinoma and a hot right hemipelvis is observed. This AXR provides proof that it is not a metastasis
  • this could be a rapid reporting film in FRCR, a good way of checking a candidate's diligence

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