Paget Disease

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Paget Disease

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Blade-of-grass sign. V-shaped lucency in metaphysis of femur

Lytic phase of Paget disease of the skull with osteoporosis circumscripta.

Lytic phase of Paget disease of the skull with osteoporosis circumscripta.

Blastic phase of Paget disease involving the calvaria. 

Mixed phase of Paget disease of the pelvis. 

Lateral radiograph of the lumbar spine in a 54-year-old woman shows cortical thickening (picture frame appearance)

Ivory vertebral body caused by Paget disease

Anterior bone scan of the pelvis and proximal femora shows intense elongated areas of increased radionuclide uptake in the left hemipelvis and right femur,

• Blade of grass: V-shaped lucency in metadiaphysis, usually in long bone, representing lytic phase
• Most often seen in femur and tibia
• In skull, lytic defect = osteoporosis circumscripta, most often seen in the frontal bone
• Findings

–Lytic, mixed, sclerotic phases

–Coarsened trabeculae, cortical thickening

–Lytic phase almost always hot on bone scan

• Complications: bowing, fx, sarcomatous degeneration (rare)

Ivory Vertebra

DDx

–Blastic mets (prostate, breast)

–Infection (TB)

–Lymphoma

–Paget disease