Paget Disease

Paget Disease

Question: Write a short note on the radiographic appearance of Paget’s disease.
Answer. The radiographic appearance of Paget’s disease consists of three radiographic stages

Paget’s disease Early Radiolucent Stage

• It is seen in the mandible. Inferior cortex may appear osteoporotic and possess a laminated structure, as the trabeculae may be altered in shape or decreased in number, and they can be long or align themselves in the horizontal linear pattern. This happen more in posterior to bicuspid region. In anterior region, bony trabeculae are coarse and are straight and normal, but they intersect producing bone spaces which are usually larger than the normal. Coarse and sparse trabeculae sometimes converge towards the midline of mandible which is suggestive of Paget’s disease.
• Root resorption is common.
• Osteoporosis circumscripta: In the skull, early lytic lesion may be seen as discrete radiolucent areas termed osteoporosis circumscripta. The margins are irregular. There is an appearance of denser bone around radiolucency.

Paget’s disease of bone

Paget’s disease Ground-Glass Appearance

• There are rounded radiopaque patches of abnormal bone of greater density within the radiolucent bone, within which it is not possible to see any actual bone structure.
• These densities may be a centimeter large or only a few millimeters in diameter.
• This pattern is much more common in the mandible than in the maxilla.

Paget’s disease symptoms

A Dense, More Radiopaque Stage

• In the later stage, rounded radiopaque patches of abnormal bone are often seen, giving an impression of cotton wool.
• As the fully opacified area becomes more numerous and enlarged, they tends to coalesce.
• The bone is denser and appears whiter on radiograph.
• Bone is enlarged and appears nearly four times its normal thickness on the lateral radiographs. Outer cortex can be thinned but remains intact and appears laminated when seen in occlusal radiograph.
• At times, irregular enlargement of the alveolar process is seen, which becomes prominent and bulgy.
• The mandible appears to be largely prognathic.

Paget’s disease skull x-ray

• In the maxilla, the disease can encroach maxillary sinus, which involves the floor, which may appear more granular and less apparent than sharp boundaries. Air space is not diminished to a greater extent.
• Involved teeth show hypercementosis while the lamina dura and periodontal ligament space are seen obliterated around hypercementosed roots. Normal roots show ankylosis.
• If osteogenic sarcoma develops, it produces frank destruction of bone. In some of the cases, soft issue shadow can be seen.