Metastatic prostate cancer

This is a patient who presents with diffuse pain. Frontal and lateral radiographs of the chest were obtained. All of the visualized axial and appendicular skeleton is abnormally sclerotic. There are scattered areas of more patchy sclerosis in both humeral heads as indicated by the red arrows. On the lateral radiograph, the lower thoracic vertabrae are abnormally sclerotic. The differential diagnosis for diffuse sclerosis involving the axial and appendicular skeleton is broad. Differential considerations include metastatic disease, sickle cell disease, and a multitude of systemic conditions such as myelofibrosis. This patient had a history of prostate cancer, with the diffusely sclerotic appearance of the skeleton representing osteoblastic metastatic disease. In a woman, the most likely malignancy to give this imaging appearance is breast cancer.