Intended for healthcare professionals

Endgames Spot Diagnosis

Plain radiography of the skull after investigation for raised calcium

BMJ 2016; 353 doi: (Published 19 May 2016) Cite this as: BMJ 2016;353:i2759
  1. David C Howlett, consultant radiologist and honorary clinical professor1,
  2. Joseph Dalby Sinnott, foundation year 2 doctor2
  1. 1Department of Radiology, East Sussex Hospitals NHS Trust, Eastbourne, UK
  2. 2East Sussex Hospitals NHS Trust
  1. Correspondence to: david.howlett{at}

A 63 year old man was being investigated for raised serum calcium and alkaline phosphatase. Plain radiography of the head was performed after a bone scan showed increased uptake in the patient’s skull. What does the radiograph show (fig 1)?

Fig 1


The radiographic findings are consistent with a diagnosis of Paget’s disease of the bone.


The lateral skull radiograph shows marked calvarial thickening, with …

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