Presentation
Chest pain, palpitations
Patient Data
The cardiomediastinal contour is unremarkable. Dual-lead cardiac pacemaker with lead tips projecting in the expected location of the right atrial appendage and right ventricular apex. No focal consolidation, lobar collapse, or cardiac decompensation. Previous midline sternotomy. Diffuse sclerosis of the imaged skeleton.
CTPA performed for chest pain shows diffuse osteoblastic metastases.
Additional findings were small right-sided effusions and small right hilar lymph nodes. An aortic valve stent (TAVI) and a dual-lead pacemaker in situ.
Laboratory testing for prostate-specific antigen (PSA) was > 900.
Case Discussion
This patient has diffuse skeletal sclerosis, for which the differential is broad. Despite the clear abnormality, this can be easily overlooked on chest XR when it involves all of the imaged bones, as it is a symmetrical process. The skeleton is an important review area.
The diagnosis in this case is diffuse sclerotic prostate metastases.
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