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Images in medicine
Islands of bone within bone
  1. Rimesh Pal1,
  2. Pinaki Dutta1,
  3. Sanjay K Bhadada1,
  4. Tukaram Bolla2,
  5. Anil Bhansali1
  1. 1 Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2 Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Anil Bhansali, Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; anilbhansaliendocrine{at}gmail.com

http://dx.doi.org/10.1136/postgradmedj-2019-136414

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    A 17-year-old boy presented with a 2-month history of pain in his right wrist. Physical examination did not reveal any local swelling, redness, tenderness or deformity. Radiograph of both wrists and hands revealed multiple symmetric, well-defined, sclerotic lesions involving the carpal bones, metacarpals and phalanges (figure 1A,B). Radiograph of pelvis showed similar lesions (figure 1D). Biochemical profile revealed normocalcaemia, normophosphataemia and age-appropriate serum alkaline phosphatase. Bone scintigraphy did not reveal any increased osteoblastic activity (figure 1C,E). Family screening showed radiologically …

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    Footnotes

    • Contributors RP prepared the manuscript. PD conceptualised the manuscript and provided overall guidance. TB helped procure the radiological images. SKB and AB edited the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.