Paget's disease progresses through three phases: an osteolytic or "hot" phase where bone is broken down irregularly, seen as a blade of grass or flame sign on x-ray; a mixed phase where new bone formation occurs in a jigsaw pattern but is improperly laid down, seen as a cotton wool skull or picture frame vertebrae; and a sclerotic or "cool" phase where bone is dense but weak, seen as a tam o'shanter skull shape on x-ray. The document provides an overview of the three phases and common radiographic findings of Paget's disease.

1. PAGET’S DISEASE
-DR BHAVANA

2. PHASES OF PAGET’S DISEASE
OSTEOLYTIC(Hot
phase)
 BLADE OF GRASS/ FLAME
SIGN
 OSTEOPOROSIS
CIRCUMSCRIPTA
MIXED
(Intermediate
phase)
 JIGSAW OR MOSAIC
PATTERN OF BONE
 COTTON WOOL SKULL
 PICTURE FRAME
VERTEBRA
SCLEROTIC (Cool
phase)
 TAM O’SHANTER

3. BLADE OF GRASS SIGN / FLAME SIGN/
ADVANCING WEDGE SIGN

4. OSTEOPOROSIS CIRCUMSCRIPTA

5. PICTURE FRAME VERTEBRAE

6. COTTON WOOL SKULL

7. TAM O’SHANTER SIGN

8. BANANA
FRACTURE

9. JIGSAW PATTERN/ MOSAIC PATTERN
OF BONE

10. BRIM SIGN

11. THANK YOU