Case Author(s): Charles Pringle, M.D., and Jerry Wallis, M.D. , 01/17/96 . Rating: #D2, #Q3

Diagnosis: Paget's disease of a vertebral body

Brief history:

Breast carcinoma, rule out osseous metastatic disease.

Images:

Anterior and posterior images

View main image(bs) in a separate image viewer

View second image(xr). lateral view of the lumbar spine

View third image(xr). Anterior view of the lumbar spine

Full history/Diagnosis is available below

Diagnosis: Paget's disease of a vertebral body

Full history:

60-year old woman with recently diagnosed right breast carcinoma. Evaluate for osseous metastatic disease.

Radiopharmaceutical:

21.8 mCi Tc-99m MDP i.v.

Findings:

Delayed whole body images demonstrate markedly increased activity within the L3 vertebral body, transverse processes, and posterior elements. Plain radiographs of the lumbar spine demonstrate sclerosis and expansion of the L3 vertebral body with a coarsened trabecular pattern. These findings are most consistent with Paget's disease.

Discussion:

This case demonstrates the importance of radiographic correlation with bone scintigraphy.

Followup:

See radiographs above.

Major teaching point(s):

Paget's disease is more often multifocal and asymmetric. There is usually markedly increased activity within the lesions. However, depending on the stage of the Paget's disease, the lesions may appear only mildly increased in uptake; sometimes a rim of increased uptake is seen along the advancing border. There is often expansion of the bone, best seen on plain radiographs. Paget's disease of the spine typically involves the entire vertebral body, as is evident in this case.

Differential Diagnosis List

Paget's disease, solitary metastasis

ACR Codes and Keywords:

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

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Case number: bs048

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