Name : Morteza
Family :Sanei Taheri
Resident : Samira Shahhamzei
Gender : Female
Age : 74
A 74 Y/O woman with pelvic pain
Imaging Procedures and Findings
Pelvic X-ray reavels sclerotic lesion in left hemipelvis .(figure 1) . MRI demonstrates abnormal low signal in T1WI in left hemipelvis with corresponding high signal in T2 fat-suppressed images. Hip joint is intact.(figure 2-4). According to patient age and imaging findings bone metastasis or lymphoma were in differential diagnosis so CT guided Bx is done . (figure 5) First BxÃ‚ was negative but second Bx was diagnostic . Before goinig to final diagnosis , please return to pelvic X-ray : Ileopectineal band thickening is evident.
Paget disease is one of the causes of osteosclerosis specially in elderly and can be monostotic . Paget disease classically causes bony enlargement but this is not always present. It occurs most commonly in the pelvis , where it has been said that the iliopectineal line on the pelvic brim must be thickened if Paget disease is present . In fact, the iliopectineal line is usually, but not always, thickened. Paget disease can occur in any bone in the body. Paget disease has three distinct phases that are visible radiographically: a lytic phase, a sclerotic phase, and a mixed lytic-sclerotic phase. The lytic phase often has a sharp leading edge, called a flame-shaped or blade-of-grass leading edge. In a long bone, with the sole exception being the tibia, Paget disease always starts at the end of the bone; therefore, if a lesion is present in the middle of a long bone and does not extend to either end, one can safely exclude Paget disease. CT can shows bone resorption, expansion, cysts or sclerosis . MRI is probably better used to assess the complications of Paget's disease related to bone expansion and subsequent relation to compromised soft tissues. In Uncomplicated disease thickened bone will be seen as low signal with thickened, irregular trabeculae interspersed with fat.
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