A 72-year-old woman underwent a chest X-ray due to respiratory infection, during which osteosclerotic lesions were incidentally observed in both humeral heads (Fig. 1). The radiologist suggested a number of possible differential diagnoses which could be: bone infarctions, osteopoiquilia, mastocytosis or Paget’s disease. The patient was then referred to the rheumatology clinic to complete the examination. A bone series was requested, highlighting multiple osteocondensing lesions located in the pelvis, carpals, metacarpals, metatarsals and knees (Fig. 2). Likewise, a bone scintigraphy was performed, without any evidence of abnormal uptake, as well as an analysis with a study of calcium-phosphorus metabolism, alkaline phosphatase, PTH, a proteinogram, serum tryptase and vitamin D, the results of which were all normal.

Figure 1.

Chest X-ray: osteosclerotic lesions in both humeral heads.

Figure 2.

X-rays of pelvis, knees, hands, and feet: multiple sclerotic lesions, rounded, gouty, small in size, and with well-defined edges, consistent with osteopoikilosis.

Osteopoikilosis or osteopoicilia is a generally asymptomatic bone dysplasia, which is usually dia1gnosed incidentally by X-ray1–5 and has a prevalence of 1/50,000 patients.2,3 The age of presentation is variable.3 It predominates in males, and familial cases with autosomal dominant inheritance have also been described.1,3,4

In 25% of cases, accompanying skin lesions may appear, in which case the condition is termed Buschke-Ollendorff syndrome.1–7

From the radiological point of view, the disease is characterised by symmetrical, well-defined foci of bone sclerosis with ovoid morphology, orientated parallel to the longitudinal axis of the bone.3,6 These lesions are typically located in epiphyses and metaphyses of long bones, as well as in the cancellous bone of the carpi and tarsals.3,4,6

In this case the bone scintigraphy was normal, which was useful in distinguishing it from other osteocondensing diseases.3–6

Differential diagnosis should include osteoblastic bone metastases, striated osteopathy, enostosis, melorheostosis, osteopetrosis, fluorosis, bone infarctions, tuberous sclerosis, mastocytosis, sarcoidosis, and Erdheim-Chester disease.1,2,6,7 The morphology and distribution of osteosclerotic lesions (diaphysis, metaphysis, epiphysis, cortical involvement, cancellous bone, or trabecular pattern) provide characteristic radiological patterns that, together with the clinical history, are usually sufficient to establish an accurate diagnosis.7

All those designated as authors have taken part in this study and thus take responsibility publicly for its content.

The patient's informed consent was obtained for the use of the image and the publication of the details of her case.

There have been no sources of funding.