5 Generalized Osteosclerosis

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig B 5-1 Myelosclerosis. Diffuse uniform sclerosis of the bones of the thorax produces an appearance of jail bars.

• Fig B 5-2 Osteoblastic metastases. (A) Carcinoma of the prostate. (B) Carcinoma of the breast.

• Fig B 5-3 Paget's disease. Diffuse sclerosis with cortical thickening involving the right femur and both iliac bones. Note the characteristic thickening and coarsening of the iliopectineal line (arrow) on the involved right side.

• Fig B 5-4 Sickle cell anemia. (A) Patchy sclerosis of the pelvic bone and vertebrae, caused by medullary infarction and dystrophic calcification. (B) In another young patient, there is dense sclerosis of the rib cage with some areas of lucency (arrows).9

• Fig B 5-5 Osteopetrosis. (A) Striking sclerosis of the bones of the hand and wrist. (B) Generalized increased density of the lower spine, pelvis, and hips in a 74-year-old woman with the tarda form of the condition.

• Fig B 5-6 Pyknodysostosis. Generalized increase in density with cortical thickening of the bones of the hand. The distal phalanges are hypoplastic, and the terminal tufts are absent.

Fig B 5-7 Melorheostosis. Dense cortical sclerosis involves the proximal femur and the lower portion of the ilium.

• Fig B 5-8 Fluorosis. (A) Dense skeletal sclerosis with obliteration of individual trabeculae causes the pelvis and proximal femurs to appear chalky white. (B) Diffuse vertebral sclerosis in another patient.10

• Fig B 5-9 Progressive diaphyseal dysplasia. Dense endosteal and periosteal cortical thickening causes fusiform enlargement and increased density of the midshafts of the radius and ulna.

• Fig B 5-10 Polyostotic fibrous dysplasia. The bones of the feet show a smudgy, ground-glass appearance of the medullary cavities with failure of normal modeling.

• Fig B 5-11 Renal osteodystrophy. Sclerosis of the long bones in a boy with chronic glomerulonephritis, renal rickets, and secondary hyperparathyroidism. In addition to the increased skeletal density, note the widened zone of provisional calcification at the ankles and the subperiosteal resorption along the medial margins of the upper tibial shafts (arrow).

Fig B 5-12 Congenital syphilis. Diffuse sclerosis with transverse bands of lucency (arrows) in the diaphyses of the femurs and tibias.

• Fig B 5-13 Sclerotic myeloma. Views of (A) the leg and (B) the femur demonstrate diffuse and nodular sclerosis. Cortical thickening of the tibia encroaches on the medullary canal. Similar changes were evident in the pelvis.11

• Fig B 5-14 Hereditary hyperphosphatasia. Areas of sclerosis about the metacarpals and middle phalanges associated with thinning of the cortices. The proximal phalanges show diffuse deossification.