Prostatic bony metastatic disease
Prostate carcinoma (not mentioned on request). Breathlessness. Infection?
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The whole of the visualised skeleton is dense, with some more discrete sclerotic foci such as in the humeri.
A few learning points from this plain radiograph:
1. Clinical information: this is not always forthcoming, but being able to interpret in its absence is an even better skill. Use historical imaging to help: prior studies (especially bone scans or CT) may be able to help confirm your suspicions.
2. Diffusely abnormal things are harder to notice. The eyes are often drawn to asymmetry.
3. Don't waste expensive resources: try to give a definite report and use the information available to you to assist. Don't send the patient for more tests with a differential for sclerotic bones when the answer can be found elsewhere.