Case 29 Increased Bony Densities Due To Osteosclerotic Metastases

The bones show patchy increased density due to metastases from carcinoma of the prostate. The differential diagnoses are Paget's disease and Fluorosis. Cancer of breast or lymphoma may also cause the same appearance. The CXR also shows right lower lobe infiltrates, suggesting aspiration pneumonia, common in the last stages of patients debilitated with cancer.

Paget Disease Breast

Case 30. This elderly male had recent onset of streaky hemoptysis. Name the radiological sign (Fig. 30.1).

Inverted Sign


There is a homogeneous density in the right upper zone and elevation of the transverse fissure. Instead of the transverse fissure being straight, there is a bulge at the medial end (Fig. 30.2), giving it an inverted S shape. Golden described this sign and the explanation for it is that the upper lobe collapse is due to a right hilar mass which accounts for the medial bulge.

Osteosclerotic Metastases
Fig. 31.1

Case 31. This diabetic presented with prolonged pyrexia of uncertain origin (PUO). Describe the CXR abnormality (Fig. 31.1).

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