Learning objectives
1.
To describe the epidemiology,
clinical features & pathology of Paget’s disease of bone
2.
To outline the radiological features of Paget’s disease in the appendicular skeleton on various imaging modalities
3.
To illustrate complications of Paget’s disease in the appendicular skeleton
Background
2.1 A BRIEF HISTORY
In 1877,
Sir James Paget (Fig 1),
a prominent British surgeon and pathologist described ‘osteitis deformans’ in five middle-aged men. Although several reports of middle-aged men whose hats no longer fit had already been published in the literature,
by the end of the century,
the affliction would become widely known as Paget’s disease of bone.
Paget described the disease as a rare,
slowly progressive inflammatory disorder which did not affect the individual’s overall general health,
but resulted in change in body...
Findings and procedure details
3.1 RADIOLOGIC PHASES OF UNCOMPLICATED PAGET’S DISEASE
3.1.1 OSTEOLYTIC PHASE
The incipient osteolytic phase is characterized by well-defined osteolysis with a leading edge of resorption. In long bones,
this sharply-demarcated,
wedge-shaped advancing edge of osteolysis is seen to advance from the subarticular or metaphyseal region into the diaphysis and is typically referred to as a ‘cutting-cone’,
‘blade of grass’,
or ‘candle flame sign’ (Fig 3).
3.1.2 MIXED OSTEOLYTIC/OSTEOSCLEROTIC PHASE
The intermediate mixed lytic/sclerotic phase is the stage at which Paget’s disease of bone is most...
Conclusion
Paget's disease of the bone demonstrates a plethora of imaging patterns.
The variable appearances which are closely linked to the pathological stage of the disease should enable the radiologist to make an early diagnosis of the condition.
In spite of the fact that the incidence of thisdisease is on the decline,
it continues to afflict many individuals whose lives are severely affected by it.
Its pathology is well-understood however its treatment remains limited to that of its many musculoskeltal complications.Recognition of the main imaging findings...
Personal information
Dr.
Gabriel Galea
Basic specialist trainee
Medical Imaging Department
Mater Dei Hospital
[email protected]
Dr.Christine Cannataci
Basic specialist trainee
Medical Imaging Department
Mater Dei Hospital
[email protected]
Dr.Christine Azzopardi
Higherspecialist trainee
Medical Imaging Department
Mater Dei Hospital
[email protected]
Dr.Adrian Mizzi
Consultant interventional radiologist
Medical Imaging Department
Mater Dei Hospital
[email protected]
Dr.Kelvin Cortis
Resident specialist
Medical Imaging Department
Mater Dei Hospital
[email protected]
References
The Ugly Duchess by Quinten Massys. The National Gallery website.
http://www.nationalgallery.org.uk/paintings/quinten-massys-an-old-woman-the-ugly-duchess
(Accessed: 16th December 2015)
Portrait of Sir James Paget by John Everett Millais. The BBC website,
arts section.
http://www.bbc.co.uk/arts/yourpaintings/paintings/sir-james-paget-18141899-126750 (Accessed: 16th December 2015)
Paget J.
On a form of chronic inflammation of bones (osteitis deformans).
Med Chir Trans 1877;60:37e64.
Cortis K,
Micallef K,
Mizzi A.
Imaging Paget’s disease of bone from head to toe.
Clinical Radiology 66 (2011) 662e672
Altman RD.
Epidemiology of Paget’s disease of bone.
Clin Rev Bone Mineral Metab 2002;1:99e102.
Ralston...