Differential Diagnosis

  • Tuberous sclerosis
  • Osteoblastic bone metastasis
  • Osteopathia striata
  • Osteopoikilosis
  • Tuberous sclerosis


The images reveal well-circumscribed sclerotic foci in the appendicular skeleton consistent with multiple bone islands. This patient was diagnosed with osteopoikilosis, also known as spotted bone disease, a sclerosing bony dysplasia characterized by multiple benign bone islands (enostoses) which are focal deposits of dense lamellar bone. This is an incidental finding.

Learnings/What to Look for

  • Osteopoikilosis is a rare inherited benign condition found incidentally on skeletal rays
  • Bone lesions are randomly distributed in a symmetric fashion
  • Osteopoikilosis is seen in the appendicular skeleton (hands, feet, long bones, pelvis) with sparing of the axial skeleton (ribs, skull, vertebrae)

Pearls for Urgent Care Management

  • Osteopoikilosis does not affect bone strength
  • Treatment is limited to pain management with nonsteroidal anti-inflammatory drugs and analgesics

Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).

A 47-Year-Old with Pain After Twisting His Ankle
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