Pagets disease of bone

Paget’s Disease of Bone

Dr.Pankaj Kaira

JR-1 Radiodiagnosis

SRMSIMS,Bareilly

Lytic phase of Paget disease of the skull in patients with osteoporosis circumscripta. Lateral radiograph of a 60-year-old woman with osteoporosis reveals frontal and occipital areas of osteolysis (*)

Lateral skull radiograph of 67-year-old woman with Paget disease shows area of osteolysis (arrowheads) in frontal region that is designated

“osteoporosis circumscripta” in lytic phase of Page disease.

Lytic phase of Paget disease (“blade-of-grass” appearance) of the appendicular skeleton in different patients. (a) Anteroposterior radiograph of the knee in a 74-year-old man shows a large area of lysis beginning in subchondral bone with a sharp inferior margin (arrowheads).

Frontal radiograph of right tibia of 67-year-old woman with Paget disease shows well-defined wedge area of osteolysis (arrow) in diaphysis of tibia and blade of- grass appearance.

Figure 11a.  Noncomplicated Paget disease of the distal femur in a 57-year-old woman. Anteroposterior radiograph of the knee shows typical cortical and trabecular thickening of the entire distal femur to subchondral bone.

Frontal radiograph of 62-year-old man with Paget disease showsthickening of iliopectineal (arrow) and ilioischial (arrowhead) lines on right side of pelvis. Coarse trabeculation and bone sclerosis are also evident as compared with uninvolved side. Contrast medium is noted in urinary bladder.

Frontal radiograph of 57-year-old man with Paget disease reveals cortical thickening (arrowheads) encasing entire T11 vertebralbody at all four margins, which manifests as picture-frameappearance. Vertebral body is enlarged and mildly compressed, and osteophytes are seen.

Images obtained of 73-year-old woman with Paget disease at femur.Frontal radiograph of distal femur reveals coarsened trabeculae, cross-hatched pattern (arrowheads), and cortical thickening (arrow).

Paget disease complicated with degenerative joint disease in 70-year-old man. Frontal radiograph shows pagetic involvement of right hemipelvis with trabecular thickening and sclerosis in ilium and along iliopectineal and ilioischial lines. Involvement of subchondral bone of ilium around acetabulum is remarkable. Symphysis pubis appears enlarged on right side. Joint space loss in superior and axial aspects of hip and mild protrusio acetabuli are noted.

Osteophytes are not prominent. Urinary bladder stone is present.

Paget disease complicated with deformity and fracture. Frontal radiograph of 73-year-old woman shows lateral bowing and bone widening of both femurs. Cortex is thickened and cortical encroachment on medullary canal is seen. Large fracture line (arrow) extends across mid diaphysis of left femur. Leftfemoral shaft displays subtle undisplaced “saw-cut” fatigue fractures (black arrowheads). In femur, fatigue fractures typically occur along lateral cortex, where tensile forces are greatest, leading to lateral bowing.Stress fracture (white arrowhead), which will most likely progress to complete fracture, is

barely seen in lateral cortex of right femur.

Paget disease complicated with malignant transformation in 81-year-old man with long history of disease. Analysis of biopsy specimen proved lesion to be osteosarcoma.Radiograph shows extensive bone destruction with osteolysis and cortical loss in distal portion of humerus. Remainder of bone shows changes of Paget disease. Associated soft-tissue mass is readilyapparent.