IS Case 120: Paget disease involving the metacarpal

Scott Mooney, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-20

History

Patient is an 80-year-old male with pain and swelling in right hand.

Findings

Expanded bone with thickened cortex and trabeculae of the third metacarpal. Remaining bones of the hand and wrist do not demonstrate similar features.

Diagnosis

Paget disease involving the metacarpal

Discussion

Paget disease (osteitis deformans) is a common, chronic progressive process of bone remodeling described by Sir James Paget in 1876. The etiology is unknown, although leading theories include a viral cause. Three stages have been described: an early phase with osteolysis from osteoclastic bone resorption, a second phase with mixed osteolytic/osteoblastic activity with a coarsened and thickened trabecular pattern and cortex, and a third blastic phase with osteosclerosis. Any bone can be affected, but most often involves the pelvis (75%), femur, skull, spine and tibia. It is initially monostotic, but most progress to be polyostotic.

Paget disease involving the hand is not common. There have been case reports of disease in the metacarpals and phalanges, and rarely in the carpals and distal phalanges. In Dr. Friedman's review of 11 cases of Paget disease involving the hand, the most common appearance was diffuse sclerosis. Both ends of the bone were affected. 5 of the patients had monostotic disease. Sarcomatous degeneration may occur in the hand, as it does in other bones.

In the case presented, the third metacarpal demonstrates trabecular and cortical thickening in an expanded bone, which places it in the second stage. The patient's disease was polyostotic, as the right iliac bone was also affected.

References

  1. # Friedman AC, Orcutt J, Madewell JE. Paget disease of the hand: radiographic spectrum. AJR Am J Roentgenol. 1982 Apr;138(4):691-3. [PMID: 6978033]
  2. Haverbush TJ, Wilde AH, Phalen GS. he hand in Paget's disease of bone: report of two cases. J Bone Joint Surg Am. 1972 Jan;54(1):173-5. [PMID: 5054446]
  3. Smith SE, Murphey MD, Motamedi K, Mulligan ME, Resnik CS, Gannon FH. From the archives of the AFIP. Radiologic spectrum of Paget disease of bone and its complications with pathologic correlation. Radiographics. 2002 Sep-Oct;22(5):1191-216. [PMID: 12235348]

1 image