This is a 65M, I have no prior imaging or additional information. I have tried to contact the referrer and await response.
There is clearly Paget Disease.
In the lateral of the LS spine I am concerned that I don’t clearly see the posterior cortex of the sacrum, wondering if there might be Paget related sarcoma.
I am also surprised by the widespread vertebral involvement, every lumbar vertebra and most of the thoracic vertebrae are sclerotic; only some are definitely enlarged.
There also seems to be relative sclerosis of the right scapula/glenoid and an indeterminate sclerotic focus in the Right intertrochanteric femur.
Here’s my Question:
How can I distinguish Paget from sclerotic mets, or superimposed sclerotic mets?
Bone scan won’t help.
I have recommended Lumbar and Pelvis CT and recommended comparison to prior if they can be made available.
Other suggestions?
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Hillary Umans
I encourage you to Register for the New OCAD Website at ocadmsk.com/ It is a distinctly separate entity from this GoogleGroup and requires a new registration and new password.
The website will archive all new cases posted to this group (searchable by any keyword in the subject line or text of the post) and will be the repository for Video conferences / lectures on demand.
Pagets-65M.pdf
[image: Paget LBP CT.jpg]
[image: Paget LBP CT1.jpg]
He returned for CT.
Now I can understand why the posterior cortex of the sacrum looked
indistinct…there is both osteolysis of the posterior sacral body and the
deep surface of the posterior elements, but there is no soft tissue mass /
component.
Can I presume that there is no suggestion of Paget related sarcoma in the
absence of a soft tissue component?
I don’t understand why there is osteolysis in the context of late stage
Paget.
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