CASE 34
By: Dr. Waleed Althobaity, MD
HISTORY: 30-year-old male asymptomatic.
What are your findings?
What is the differential diagnosis?
What is the diagnosis?
FINDINGS:
Anteroposterior radiograph of hand and (B) AP radiograph of the wrist show multiple small, well defined uniform sclerotic lesion epiphyseal in location involving tubular bones and carpus. Old head fracture at fifth metacarpal neck is noted.
AP radiograph of forefoot shows similar lesions clustered around the joints oft the tubular bones.
DIFFRENTIAL DIAGNOSIS:
Osteopoikilosis.
Osteopathia striata (Voorhoeve’s disease).
Tuberous sclerosis.
Sclerotic metastasis (less likely).
DIAGNOSIS:
Osteopoikilosis.
PEARLS AND DISCUSSION:
Osteopoikilosis (spotted bones) is an asymptomatic osteosclerotic dysplasia. Both inherited and sporadic cases have been reported. Clinical manifestations are usually absent or mild. Radiographic findings are diagnostic. Numerous small, well-defined, homogeneous circular or ovoid foci of increased radiodensity are clustered in periarticular osseous regions. A symmetrical distribution is observed, with a predilection for the epiphyses and metaphysis of the long tubular bones, carpus, tarsus, pelvis, and scapula; involvement of the ribs, clavicle, spine, or skull is rare and, when present, is less marked.
Some evidence suggests that a relationship exists between this condition and other osteosclerotic skeletal disorders, especially osteopathia striata and melorheostosis.
Osteopathia striata radiography reveals linear, regular bands of increased radiodensity that extend from the metaphysis of tubular bones for variable distances into the diaphysis.
The tubular sclerosis lesions are predominately involving spine and pelvis and usually show ill define sclerotic lesions. The uniform shapes, symmetrical distribution and location are against the osteoblastic metastasis.
FURTHER READINGS:
Bone and Joint Imaging, 3rd Edition. By Donald L. Resnick, MD, Mark J. Kransdorf, MD, Donald L. Resnick, MD and Mark J. Kransdorf, MD.
Greenspan, Adam; Borys, Dariusz (2015-09-21). Radiology and Pathology Correlation of Bone Tumors: A Quick Reference and Review (Kindle Locations 1607-1609). LWW. Kindle Edition.
