Paget disease of the scapula

Case contributed by Dr Nick Tarasov


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. 

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