Presentation
Chronic back pain for 17 years, prior L5-S1 posterior fusion. No history of malignancy or trauma. History of bilateral adrenal adenomas.
Patient Data
Whole-body bone scan demonstrates abnormal increased radiotracer uptake within the lower thoracic spine at the border of T10 and T11, right greater than left. Increased uptake in the lumbosacral region may be due to degenerative or postsurgical changes.
Cortical thickening and trabecular thickening of the T10 vertebra including the vertebral body and spinous process. Suggestion of similar features in the L3 vertebra. Multilevel degenerative disc disease with vacuum disc phenomenon. Grade 2 anterolisthesis at L4-L5. Partially imaged lumbosacral spinal fusion hardware at L5-S1.
Bilateral adrenal adenomas, with low attenuation on the non-contrast images and washout on the delayed post-contrast images.
Case Discussion
Paget disease causes disorganized new bone formation, often affecting the vertebrae. This abnormal bone growth together with increased metabolic activity in the pedicles and spinous process leads to increased radiotracer uptake on bone scintigraphy resembling Mickey Mouse 1.
Picture frame vertebra, most commonly seen in the mixed phase of Paget disease, represents both osteoclastic activity with the development of disorganized, trabecular mesh and osteoblastic activity signified by cortical thickening along all four margins of the vertebral body 2.
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