Question:medium
X-ray of skull showing which lesions in the brain:
X-ray of skull showing which lesions in the brain:
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Cotton-wool mixed lytic-sclerotic skull with thickened diploe, inner table spared.
Updated On: Jun 23, 2026
- Paget's disease
- Multiple myeloma
- Osteosarcoma
- Osteomyelitis
Show Solution
The Correct Option is A
Solution and Explanation
Step 1: Read the calvarium texture - patchy areas of dense fluffy sclerosis mixed with lucency, often described as cotton-wool spots, plus a thickened diploe. This texture is the hallmark of Paget disease.
Step 2: The disease is driven by disordered, accelerated bone turnover. In the skull it opens with an outer-table lytic phase (osteoporosis circumscripta) and later swings to a reparative sclerotic phase that thickens the outer table and diploic space.
Step 3: A useful discriminator is that the inner table and cranial cavity are preserved, unlike aggressive tumors that breach inward.
Step 4: Contrast with mimics - myeloma produces same-size punched-out holes with no surrounding sclerosis, osteosarcoma gives a sunburst spiculated mass, and osteomyelitis yields moth-eaten lysis with a sequestrum. The blended lytic-sclerotic cotton-wool skull fits Paget alone. \[\boxed{\text{Paget's disease}}\]
Step 2: The disease is driven by disordered, accelerated bone turnover. In the skull it opens with an outer-table lytic phase (osteoporosis circumscripta) and later swings to a reparative sclerotic phase that thickens the outer table and diploic space.
Step 3: A useful discriminator is that the inner table and cranial cavity are preserved, unlike aggressive tumors that breach inward.
Step 4: Contrast with mimics - myeloma produces same-size punched-out holes with no surrounding sclerosis, osteosarcoma gives a sunburst spiculated mass, and osteomyelitis yields moth-eaten lysis with a sequestrum. The blended lytic-sclerotic cotton-wool skull fits Paget alone. \[\boxed{\text{Paget's disease}}\]
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