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

Differential Diagnosis

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

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Diagnosis

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).