Case Author(s): Feiyu Xue, M.D., Ph.D. and Keith C. Fischer, M.D. , 6/29/04 . Rating: #D2, #Q3

Diagnosis: Osteomesopyknosis

Brief history:

14-year-old boy complains of back pain in the lower thoracic spine and lumbar spine area.

Images:

Delayed whole body bone Scintigraphy

View main image(bs) in a separate image viewer

View second image(xr). L-spine radiograph

View third image(xr). L-spine radiograph

Full history/Diagnosis is available below

Diagnosis: Osteomesopyknosis

Full history:

14-year-old boy with a rare form of bone dysplasia, osteomesopyknosis, complains of back pain in the lower thoracic spine and lumbar spine area.

Radiopharmaceutical:

13.7 mCi MDP i.v.

Findings:

Delayed whole-body scintigrams were obtained. In addition, tomographic (SPECT) images of the thoracolumbar spine were obtained (not shown). There is diffusely increased tracer uptake, most prominent in the thoracolumbar spine. There is no fracture identified. There is scoliosis.

Discussion:

Osteomesopyknosis is a rare autosomal dominant condition characterized by osteosclerosis of the axial skeleton. Its radiological abnormalities consist of increased density of the vertebral plates, pelvis, and sometimes of the upper part of the femurs. It is usually discovered incidentally on radiographic examination, is a mild form of familial osteosclerosis and must be distinguished from osteopetrosis which carries a worse prognosis. A marked increase uptake may be found on bone scintigraphy. Microscopic examination of bone shows an increase of trabecular thickness, and a low rate of bone turnover.

Reference:

Delcambre B, Flipo RM, Leroux JL, Duquesnoy B. Osteomesopyknosis. Report of two new cases. Skeletal Radiol. 1989;18(1):21-4.

Major teaching point(s):

Increased uptake on bone scan is not specific. In this case of diffusely increased uptake in the thoracic and lumbar spine, the findings could be subtle. Diffusely increased uptake is usually due to a metabolic disorder, congenital (as in this case) or acquired(such as renal osteodystrophy), an infiltrative process (such as myelofibrosis), or neoplasm (leukemia or lymphoma). In this patient of young age, a metabolic bone disorder is most likely.

Differential Diagnosis List

metabolic bone disorder leukemia/lymphoma

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Other generalized systemic disorder)

Search for similar cases.

Edit this case

Add comments about this case

Return to the Teaching File home page.

Case number: bs141

Copyright by Wash U MO