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Paget Disease of Bone : Radiology

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Paget Disease of Bone (PDB) - Imaging Studies: PDB is often discovered incidentally on imaging studies performed for another indication. The radiologic appearance depends upon the stage of the disease. In the initial stages, when osteoclastic activity is predominant, there is radiolucency with no thickening of the involved bone.

In the long bones, the changes begin at one or sometimes both ends and spread to the center. The demarcation between the normal and the diseased bone is sharp. During lytic phase, the affected bone shows a flame-shaped lucent leading edge - a finding known as flame sign or blade of grass sign. In the long bones, early lesions can mimic malignancy. Early lytic lesions in skull have been referred to as osteoporosis circumscripta.

Case History: This plain X-ray is from a 75 y/o female with leg pain and markedly elevated serum alkaline phosphatase. A well defined, wedge shaped lytic lesion in the right femoral diaphysis is seen, with no evidence of periosteal reaction or cortical disruption. Findings are consistent with osteolytic phase of Paget disease. The blade of grass or the flame sign is a wedge- or V-shaped radiolucency typically located in the diaphysis of long bones such as femur or tibia.

Case courtesy of Dr Ivan Turkalj, Radiopaedia.org. From the case rID: 51018

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