Question 1808
{"accessible":true,"alternatives":[{"id":8982,"text":"bone metastases"},{"id":8983,"text":"fibrous dysplasia"},{"id":8985,"text":"Paget disease"},{"id":8986,"text":"hyperparathyroidism"},{"id":8987,"text":"multiple myeloma"}],"archived":false,"correctAlternativeId":8985,"explanation":"\u003cp\u003eThis skull radiograph demonstrates:\u003c/p\u003e\u003cul\u003e\n\u003cli\u003e\u003cp\u003ethickened, disorganized trabeculae with extensive poorly defined sclerotic patches giving the typical \"cotton wool appearance\"\u003c/p\u003e\u003c/li\u003e\n\u003cli\u003e\u003cp\u003ewidening of the diploic\u0026nbsp;space: both inner and outer calvarial tables are involved\u003c/p\u003e\u003c/li\u003e\n\u003cli\u003e\u003cp\u003erelatively well-defined lytic lesion involving mainly the outer calvarial table of the occipital bone which may represent an osteoporosis circumscripta\u003c/p\u003e\u003c/li\u003e\n\u003cli\u003e\u003cp\u003eTam o' Shanter sign:\u0026nbsp;with the appearance of the skull falling over the facial bones, like a Tam o' Shanter hat\u003c/p\u003e\u003c/li\u003e\n\u003cli\u003e\u003cp\u003eplatybasia\u0026nbsp;and\u0026nbsp;basilar invagination\u0026nbsp;can not be properly appreciated on this skull radiograph\u003c/p\u003e\u003c/li\u003e\n\u003c/ul\u003e\u003cp\u003eThe clinical history of a chronic bone disorder, with\u0026nbsp;marked\u0026nbsp;elevation of the\u0026nbsp;serum alkaline phosphatase and radiographic features are highly suggestive of Paget disease.\u003c/p\u003e","id":1808,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/294/paget-disease-of-the-skull-3_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":75040},"imageAttributionCaseInfo":{"title":"Paget disease of the skull","contributor_name":"Leonardo Cordeiro Nascimento","contributor_param":"leonardo-3","case_rid":75040,"case_param":"paget-disease-of-the-skull-3"},"firstQuestionPath":"/questions/2230","nextQuestionPath":"/articles/multiple-myeloma-1/questions/1194","relatedArticles":[{"id":1477,"title":"Hyperparathyroidism","link":"/articles/hyperparathyroidism?lang=us"},{"id":1892,"title":"Platybasia","link":"/articles/platybasia?lang=us"},{"id":10024,"title":"Basilar invagination","link":"/articles/basilar-invagination?lang=us"},{"id":7803,"title":"Osteoporosis circumscripta cranii","link":"/articles/osteoporosis-circumscripta-cranii?lang=us"},{"id":1174,"title":"Cotton wool appearance (bone)","link":"/articles/cotton-wool-appearance-bone?lang=us"},{"id":2146,"title":"Tam o' Shanter sign (skull)","link":"/articles/tam-o-shanter-sign-skull-1?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eAn 80-year-old woman known for a chronic bone disorder with markedly elevated serum alkaline phosphatase.\u0026nbsp;What is the most likely chronic bone disease shown on her lateral skull radiograph?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1808"}],"attemptsPercentages":[{"alternativeId":"8987","percentage":9},{"alternativeId":"8983","percentage":2},{"alternativeId":"8985","percentage":72},{"alternativeId":"8986","percentage":14},{"alternativeId":"8982","percentage":3}],"promptToLogin":false,"questionManager":false,"articleId":"multiple-myeloma"}