Muppet is afraid of losing our audience and insists on showing easy cases. Here we are presenting radiographs belonging to a 54-year-old man with skin lesions.
What do you see? Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.
Findings: chest radiographs show a generalised increase in bone density, more obvious in the dorsal spine in the lateral view.
There also unspecific lineal shadows in both lungs. Radiographs of pelvis and lumbar spine confirm the widespread increased bone density.
The most common condition to produce this appearance is renal osteodystrophy, which can be excluded because of normal renal function. A good possibility is myelosclerosis, unlikely because the spleen is not enlarged in the PA film.
Diagnosis was made because the patient had urticarial lesions with pruritus, suggesting the diagnosis or urticaria pigmentosa, confirmed by biopsy.
Final diagnosis: systemic mastocytosis.
Lung involvement has been described in this condition. I am no expert in mastocytosis and lung biopsy was not done, but there is improvement in the lineal shadows in a PA radiograph taken two years later.
Congratulations to Fernando, who made the correct diagnosis.
Teaching point: radiographs were shown to emphasise that the majority of us don’t look at the chest bones and may miss important diseases, as proved by this case.
