1. The document describes and shows images of various medical conditions that result in generalized osteosclerosis, or increased bone density, seen on clinical imaging. 2. These conditions include myelosclerosis, Paget's disease, sickle cell anemia, osteopetrosis, pyknodysostosis, melorheostosis, fluorosis, progressive diaphyseal dysplasia, polyostotic fibrous dysplasia, renal osteodystrophy, congenital syphilis, sclerotic myeloma, and hereditary hyperphosphatasia. 3. For each condition, the document provides a brief description and labeled image showing the patterns of sclerosis visible on imaging of the

1. 5Generalized Osteosclerosis

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig B 5-1 Myelosclerosis. Diffuse uniform
sclerosis of the bones of the thorax produces
an appearance of jail bars.

4. • Fig B 5-2 Osteoblastic metastases. (A)
Carcinoma of the prostate. (B) Carcinoma of
the breast.

5. • Fig B 5-3 Paget's disease. Diffuse sclerosis with
cortical thickening involving the right femur
and both iliac bones. Note the characteristic
thickening and coarsening of the iliopectineal
line (arrow) on the involved right side.

6. • Fig B 5-4 Sickle cell anemia. (A) Patchy
sclerosis of the pelvic bone and vertebrae,
caused by medullary infarction and dystrophic
calcification. (B) In another young patient,
there is dense sclerosis of the rib cage with
some areas of lucency (arrows).9

7. • Fig B 5-5 Osteopetrosis. (A) Striking sclerosis
of the bones of the hand and wrist. (B)
Generalized increased density of the lower
spine, pelvis, and hips in a 74-year-old woman
with the tarda form of the condition.

8. • Fig B 5-6 Pyknodysostosis. Generalized
increase in density with cortical thickening of
the bones of the hand. The distal phalanges
are hypoplastic, and the terminal tufts are
absent.

9. Fig B 5-7 Melorheostosis. Dense cortical sclerosis involves the
proximal femur and the lower portion of the ilium.

10. • Fig B 5-8 Fluorosis. (A) Dense skeletal sclerosis
with obliteration of individual trabeculae
causes the pelvis and proximal femurs to
appear chalky white. (B) Diffuse vertebral
sclerosis in another patient.10

11. • Fig B 5-9 Progressive diaphyseal dysplasia. Dense
endosteal and periosteal cortical thickening causes
fusiform enlargement and increased density of the
midshafts of the radius and ulna.

12. • Fig B 5-10 Polyostotic fibrous dysplasia. The
bones of the feet show a smudgy, ground-glass
appearance of the medullary cavities with failure
of normal modeling.

13. • Fig B 5-11 Renal osteodystrophy. Sclerosis of the long bones in a boy with chronic
glomerulonephritis, renal rickets, and secondary hyperparathyroidism. In addition to the increased
skeletal density, note the widened zone of provisional calcification at the ankles and the
subperiosteal resorption along the medial margins of the upper tibial shafts (arrow).

14. Fig B 5-12 Congenital syphilis. Diffuse sclerosis with transverse bands of
lucency (arrows) in the diaphyses of the femurs and tibias.

15. • Fig B 5-13 Sclerotic myeloma. Views of (A) the leg and
(B) the femur demonstrate diffuse and nodular
sclerosis. Cortical thickening of the tibia encroaches on
the medullary canal. Similar changes were evident in
the pelvis.11

16. • Fig B 5-14 Hereditary hyperphosphatasia. Areas of
sclerosis about the metacarpals and middle phalanges
associated with thinning of the cortices. The proximal
phalanges show diffuse deossification.