Paget disease of the scapula

Case contributed by Dr Nick Tarasov

Presentation

No complaints, follow-up bone scan for prostatic cancer.

Patient Data

Age: 65 years
Gender: Male
Nuclear medicine

There are two regions with high Tc-99m diphosphonate uptake - scapula and second cervical vertebra.

Nuclear medicine

Diffuse sclerotic changes with coarsened trabeculae of the scapula, coracoid, acromion processes, and posterior elements of C2 on the right with high Tc-99 MDP uptake.

The inferior part of the scapula lesion demonstrates spiculated periosteal reaction, suspicious for potential malignant changes.

Also seen a high Tc99m uptake in the region of the supraspinatus tendon, probable due to degenerative changes - subacromial impingement.

Case Discussion

Paget disease is an uncommon disorder of the osteoblastic/osteoclastic balance activity mainly with the non-symptomatic course. Usually, it affects pelvic bones, lower vertebrae, and long bones.

This case demonstrates a rare distribution of the Paget disease involving a scapula and C2 vertebra. In rare cases, it may progress to osteosarcoma. Irregular outer bone margins with spiculated periosteal reaction is a key finding to suspect malignant progression. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.