Alsaleh Bano, Alanzi Ahmed, Aladel Fouad
Radiology Department, King Hamad University Hospital, Muharraq, Kingdom of Bahrain.
Anaesthesia and Critical Care Depratment, King Hamad University Hospital, Muharraq, Kingdom of Bahrain.
Radiol Case Rep. 2025 Mar 20;20(6):2886-2890. doi: 10.1016/j.radcr.2025.02.072. eCollection 2025 Jun.
Paget disease of bone is a chronic skeletal disorder characterized by abnormal bone remodeling. This condition, which predominantly affects older adults, can result in a variety of complications, including bone pain, fractures, and deformities. This case report discusses the incidental discovery of monostotic Paget's disease involving the scapula, leading to brachial plexopathy in a 58-year-old female with a history of colon cancer. The patient had severe bilateral shoulder pain, predominantly on the left, for the past ten years. This pain, exacerbated by overhead activity and limiting daily functions, radiated to the upper limbs without causing weakness or sensory deficits. Clinical examination revealed 4/5 limb power and normal sensation, with significant pain on left shoulder movement and limited elevation. Radiographic investigations, including bilateral shoulder radiographs, contrast-enhanced computed tomography (CT), and cervical magnetic resonance imaging (MRI), identified no displaced fractures but showed diffuse enlargement of left shoulder muscles with fatty infiltration, medullary expansion of the scapula, and reduced left lung volume. MDP skeletal scintigraphy with SPECT/CT confirmed asymmetrical radiotracer uptake and medullary expansion in the left scapula. Further, MRI of both shoulders revealed left-sided expansion, cortical thickening, and fatty replacement of the rotator cuff and deltoid musculature due to denervation pseudohypertrophy from left brachial plexopathy. The right shoulder MRI showed rotator cuff tendinopathy and tears. The findings suggest a diagnosis of monostotic Paget's disease with secondary brachial plexopathy.
骨佩吉特病是一种以异常骨重塑为特征的慢性骨骼疾病。这种疾病主要影响老年人，可导致多种并发症，包括骨痛、骨折和畸形。本病例报告讨论了一名58岁有结肠癌病史的女性偶然发现的单发性佩吉特病累及肩胛骨，导致臂丛神经病变。患者在过去十年中双侧肩部严重疼痛，主要是左侧。这种疼痛因上肢活动而加重，限制了日常功能，放射至上肢但未引起无力或感觉障碍。临床检查显示肢体肌力4/5，感觉正常，左肩活动时疼痛明显，抬高受限。影像学检查，包括双侧肩部X线片、增强计算机断层扫描（CT）和颈椎磁共振成像（MRI），未发现移位骨折，但显示左肩肌肉弥漫性肿大伴脂肪浸润、肩胛骨骨髓扩张和左肺容积减小。MDP骨闪烁显像联合SPECT/CT证实左肩胛骨放射性示踪剂摄取不对称和骨髓扩张。此外，双肩MRI显示由于左臂丛神经病变导致的失神经假性肥大，左侧出现扩张、皮质增厚以及肩袖和三角肌脂肪替代。右肩MRI显示肩袖肌腱病和撕裂。这些发现提示诊断为单发性佩吉特病伴继发性臂丛神经病变。
