Read the Radiograph

Partha Pratim Chakraborty MD, DM, DNB, FRCP, FACE, FICP
Assistant Professor, Department of Endocrinology and Metabolism, Medical College, Kolkata

A 16-year-old boy with multiple bony deformities and recurrent low-grade trauma fractures was treated with a particular agent.

1. Identify the underlying disease
2. Name the therapeutic agent

1. Note the radiolucent areas (white arrows) within both tibial bones, left fibula (A), metatarsals and phalanges (B) with thinned out cortical margins suggesting polyostotic fibrous dysplasia. This boy also had large café-au-lait macules with ‘coast of Maine’ appearance. He was diagnosed as McCune Albright syndrome.

2. The boy was treated with four intravenous infusions of zoledronic acid. Note multiple radio dense lines over ends of the long bones (yellow arrows). This is called “Zebra Stripe” sign. This is seen with cyclical bisphosphonate therapy and the number of the radio dense lines represent number of infusions.