Case Author(s): Thomas H. Vreeland, M.D., Tom R. Miller, M.D., Ph.D. , 08/26/94 . Rating: #D2, #Q3

Diagnosis: Paget's Disease

Brief history:

54 year-old man with low back pain.


Bone Scintigraphy

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Full history/Diagnosis is available below

Diagnosis: Paget's Disease

Full history:

54 year-old man with low back pain associated with an injury in January, 1994. The pain has gradually worsened over the past eight months.


(1) Markedly increased bone uptake involving the calvarium, right humerus, right forearm, the left tibia/fibula and the distal right femur in a pattern characteristic of Paget's Disease.

(2) Left pelvic kidney

(3) Increased uptake at L2

(4) Mildly increased activity in a lesion involving the distal left humerus

(5) Subtle area of increased activity involving the left superior pubic ramus and left ischium as well as well degenerative changes and costochondral junction activity


Paget's disease, along with fibrous dysplaysia, leads to the most intensely increased uptake seen by bone scintigraphy. Typically a large contiguous section of bone is involved. The activity at L2 may be due to Paget's disease with a suggestion of expansion of the vertebral body.

Differential Diagnosis List

1. Paget's disease.

2. Fibrous dysplasia.

3. Selected lesions could be due to metastases, infection or trauma (much less likely)

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Misc)

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Case number: bs010

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