Weekly Case

Title : Case 866

Age / Sex : 54 / F

Chief complaint : Pelvic pain ( 1 month ago)
PHx : Hypoparathyroidism

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)

Courtesy : 한 석(Seok, Hahn), 인제대학교 해운대 백병원 (Inje University Haeundae Paik Hospital)


Paget's disease


Predominant osteosclerosis with cortical and trabecular thickenings involving the sacrum and L5.
- Decreased capacity of bone marrow
- Prominent regional yellow marrow
- No evidence of cortical destructions or soft tissue lesion

1. Plain films and CT
Lytic phase : Well defined osteolysis
Mixed phase (the vast majority of cases) : Coarsening and thickening of the trabecular pattern and cortex
Blastic phase : Development of osteosclerosis, bone enlargement

2. MRI (bone marrow evaluation)
Lytic phase : Heterogeneous SI on both T1WI and T2WI, containing small to extensive yellow marrow on T1WI
Mixed phase : Yellow marrow SI is maintained (actually has more fat than found in the uninvolved bone, a finding that represents the atrophic marrow)
Blastic phase : Low SI on T1WI and T2WI (representing sclerosis)

1. Radiologic spectrum of Paget disease of bone and its complications with pathologic correlation, RadioGraphics 2002; 22:1191-1216
2. 근골격 영상의학, 대한근골격영상의학회

Correct Answer
Total applicants 27 Correct answers 14
Name Institution
곽경수 전문의
이규정 고려대학교 안암병원, 전문의
전인환 전문의
김동일 전공의
김재민 원주연세병원, 전문의
김지환 전문의
유현규 전문의
김민수 전공의
윤유성 경북대학교병원, 전문의
문지혜 전문의
박미현 충북대학교병원, 전공의
송윤아 전문의
전예진 전문의
권지민 전공의
Semi-Correct Answer
Total applicants 27 Semi-Correct answers 1
권용재 삼성서울병원, 전공의