Presentation
Nuclear medicine bone scan for high PSA
Patient Data
Nuclear medicine bone scan showed diffused intense skull activity. The activity extends to involve bilateral orbits and maxilla.
Diffused ground glass opacity on low dose CT. There are also mixed lytic and sclerotic regions of the skull compatible with cotton wool appearance. Note is also made of diploic widening of the skull.
Case Discussion
The scintigraphic features and low dose CT findings are most compatible with Paget disease.
The patient was asymptomatic.
Other clinical features of Paget's disease which are not present in this case:
Fatigue, pain, tenderness
Increase hat size
Hyperthermia from hypervascularity
Cranial nerve deficit(s), pulsatile tinnitus
New pain/swelling → malignant transformation
High output cardiac failure, heart block
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