HISTORY: 57 Year old femal complains of pain in left hip.

EXAM: Plain film image of pelvis followed by whole body bone scan.

FINDINGS: Plain film: Cortical thickening of right proximal femur with patchy sclerotic changes in the proximal femur.
Whole Body Bone Scan: Focal uptake of tracer noted in the right proximal femur in a "flame" or "blade of grass" distribution corresponding to the plain film image. Focal uptake noted in the anterior and posterior projections of L2, left sacroiliac joint and the right ankle.

DIFFERENTIAL DIAGNOSIS: Paget's disease, primary bone tumor or bony metastasis, less likely fibrous dysplasia.

DIAGNOSIS: Paget's Disease

DISCUSSION: Paget's is a usually asymptomatic entity affecting patients >40 years old more commonly in males. The radiograph and bone scan images presented are consistant with Paget's disease. Bone scan is an excellent modality for the imaging of paget's due to its sensitivity and ability to scan the whole body in one setting. The expansile appearance of the vertebral body with radiotracer uptake involving the entire vertebrae is highly suggestive of paget's, also the "blade of grass" appearnace is very suggestive of paget's.