AJR Teaching File: Diffuse Osteosclerosis with Hepatosplenomegaly

Abstract

Case History A 59-year-old man presents with left flank pain. Radiologic Description Frontal radiography of the abdomen (Fig. 1A) shows diffuse osteosclerosis and concurrent severe splenomegaly and hepatomegaly. Subsequent contrast-enhanced CT of the abdomen (Fig. 1B) verifies the presence of increased bone density secondary to organized trabecular thickening and deposition along the endosteal cortex. The patient went on to MRI, and an axial T1-weiglited MR image (Fig. 1C) through the abdomen shows decreased signal intensity of the normally bright fatty bone marrow. A coronal T2-weighted MR image (Fig. ID) through the spine reveals homogeneously decreased signal intensity of the marrow. Differential Diagnosis The differential diagnosis for increased bone density is metabolic disorders (such as hyperthyroidism, hypoparathyroidism, renal osteodystrophy), fluorosis, myelofibrosis, mastocytosis, lymphoma, osteopetrosis, osteoblastic metastases, Paget's disease, and sickle cell anemia.