Sclerotic foci were detected incidentally in an adult with no clinical findings.
Sclerotic foci were detected incidentally in an adult with no clinical findings.
Osteopoikilosis is an asymptomatic and not infrequent osteosclerotic dysplasia. On histology these foci are formed by dense trabeculae of spongious bone, sometimes forming a nidus without communication with bone marrow. The aetiology of this asymptomatic condition is an inherited autosomal disorder, according to some authors more frequently seen in males and sometimes associated with other mesenchymal disorders such as the presence of skin nodules and formation of cheloid scars. The shoulders, hips and sacrum are especially good places to look for these findings. Clinical manifestations are usually absent or mild.
On radiography, small, well-defined, ovoid foci of increased radiodensity are clustered in periarticuler osseous regions. These little deposits of bone are essentially multifocal bone islands. A symmetrical distribution is observed, with a predilection for the epiphysis and metaphysis of long and short tubular bones, carpus, tarsus, pelvis and scapulae. Involvement of the ribs, clavicles, spine, and skull is rare.
Radionuclide examination with bone-seeking radiopharmaceutical agents usually reveals no evidence of increased activity around the skeletal lesions. Pathologically, the lesions of osteopoikilosis appear as oval or round foci of compact bone within the spongiosa. Some evidence suggests that a relationship exists between this condition and other sclerotic skeletal disorders, especially osteopathie striata and melorheostosis. The resulting combination of abnormalities has been referred to as mixed scleroting bone dystrophy.
The major differential diagnostic considerations in cases of osteopoikilosis are osteoblastic metastasis, mastocytosis, and tuberous sclerosis. The symmetrical distribution, the propensity for epiphyseal and metaphyseal involvement, and the uniform size of the foci are features that suggest osteopoikilosis, a diagnosis that is supported by a bone scan of normal appearance.
Osteopoikilosis
Based on the X-ray and CT images of the spine and knee joints provided, multiple well-defined oval or round sclerotic lesions can be observed, presenting as high-density lesions mainly located in the epiphyses and metaphyses, with some involving the cancellous bone of long bones and vertebral bodies. The overall bone structure remains intact, with no apparent signs of bone destruction or fracture, and no obvious soft tissue swelling or abnormal density changes.
On CT, these sclerotic lesions also manifest as dense, bone-like areas. The lesions are relatively uniform in size, some of which are scattered yet symmetrically distributed.
Taking into account the patient’s age (25-year-old male), absence of specific clinical symptoms or signs, and the imaging characteristics of multiple, symmetrical, oval-shaped sclerotic lesions of relatively uniform size, along with the lack of any history of malignant tumors or systemic abnormalities, the most likely diagnosis is:
Osteopoikilosis (also known as “spotted bone disease”)
This condition is generally benign and self-limiting. Most patients are asymptomatic or experience mild symptoms, and bone scans and further tests often yield normal results. Typically, no special treatment is necessary, and routine follow-up is sufficient.
Since osteopoikilosis is usually benign, asymptomatic or mildly symptomatic, special treatment is often unnecessary. The primary goal is to maintain bone health and reduce unnecessary anxiety:
This report is a reference analysis based on the provided imaging and medical history. It does not replace professional in-person evaluation or further diagnostic procedures by qualified healthcare providers. If concerns arise or symptoms worsen, consulting a specialist promptly is recommended.
Osteopoikilosis
