Differentiating osteopoikilosis from osteoblastic metastases

Osteopoikilosis is a rare, benign osteosclerotic dysplasia that predominantly involves the appendicular skeleton. Radiographic findings are diagnostic, and the disease often is discovered incidentally on x-ray films. The importance of recognizing osteopoikilosis lies in differentiating it from osteoblastic metastases. The cause is unclear. Patients typically are asymptomatic. Diagnostic findings include the appearance of numerous small,well-defined, spheroid sclerotic foci. Because evidence suggests an association with skeletal and dermatological changes, evaluation for coexisting pathological conditions may be warranted. The differential diagnosis for a patient who has radiographic characteristics similar to those of osteopoikilosis includes osteoblastic metastases, mastocytosis, tuberous sclerosis, melorheostosis, and osteopathia striata. (J Musculoskel Med.