Keywords:
Bones, Musculoskeletal bone, Digital radiography, CT, Diagnostic procedure, Infection, Pathology
Authors:
R. Johnson, R. Chowdhury, R. Chari, C. McCarthy, R. Mansour, J. Teh; Oxford/UK
DOI:
10.1594/essr2016/P-0136
Imaging findings OR Procedure Details
Three phases are classically described in Paget’s disease:
1) Lytic (incipient active) - active phase in which osteoclastic activity dominates
2) Mixed (active)- osteoblastic activity occurs alongside osteoclasts
3) Sclerotic (late inactive)- results in disorganised,
thickened bone
Recrudescence of Paget’s can be seen in the post-operative setting,
where a patient with a history of stable disease has a non-related surgical intervention.
This will typically involve the insertion of metalwork,
commonly post trauma or arthroplasty.
The findings of a rapid,
new postoperative osteolysis can be alarming and mimic the features of infection or even tumour.
The osteolysis in a recrudescence of Paget’s will begin in a subarticular location,
and careful review of previous imaging will demonstrate a history of stable osteitis deformans.
Follow up radiographs will show that the lucency stabilises.
Whilst a rare entity,
it remains an important consideration given the potential serious clinical impact of misdiagnosis.
Infection can also manifest as a new rapid onset lucency however the patient is often clinically unwell,
with local and/or systemic symptoms as well as elevated inflammatory markers.