Paget's disease remains common in older patients with European ethnicity affecting 3-4% over 40 year olds. It is rare in those from Scandinavia or with Asian/African ethnicities ^1,2.

Pagetoid involvement of the sternum is rare and when it occurs can make procedures necessitating a sternotomy, e.g. CABG, challenging ².

An interesting learning point demonstrated is the poor sensitivity of bone scintigraphy for Paget disease. If one compares the bone scan with the radiographs and CT, several parts of the right hemipelvis show little activity on the functional study, whilst the structural imaging shows diffuse involvement of all three bones of the hemipelvis. Research has shown that scintigraphy tends to show a lack of tracer uptake in quiescent areas of the disease ¹.

This case is a nice example of how concern about one thing, i.e. renal impairment, leads to a test MAG-3 which raises concerns of a renal lesion, leading to a CT, which in turn raises concerns about the skeleton leading to further imaging.