Paget disease: cotton wool skull

Case contributed by Dr Ian Bickle

Presentation

Thickening of frontal bone and pain.

Patient Data

Age: 70 years
Gender: Male
X-ray

Thickened diploe of the skull and ill-defined 'fluffy' sclerotic areas most pronounced in the frontal bone.

Case Discussion

The cotton wool appearance is a plain film sign on the lateral skull radiograph in Paget disease.

The appearances result from widening of the diploe of the skull with thickened, disorganized trabeculae.

Sclerotic ill-defined ''patches'' appear fluffy like cotton wool.

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