Radiology · patient case question
How would you describe the observed radiographic pattern?
Patient case: Bilateral jaw expansion in a young child
Patient: Male, 6 years old
Chief complaint: "His cheeks have been getting fuller on both sides for about a year. It does not hurt him."
History: Otherwise healthy. No trauma, no fever, no weight loss. The father was told as a child that he had "chubby cheeks" that settled on their own during his teens.
Findings: Painless, firm, bilaterally symmetric expansion of the posterior mandible. Lymph nodes not enlarged. Panoramic and PA radiographs show bilateral, symmetric, expansile multilocular radiolucencies of the mandible with displaced and unerupted teeth.
Show answer and explanation
Correct answer: D. Multilocular
- A. A cotton-wool appearance — patchy radiopacities on a dense background — belongs to the late osteoblastic phase of Paget disease of bone, a condition of older adults.
- B. A ground-glass or granular pattern with poorly defined margins indicates fibrous dysplasia, which is characteristically UNILATERAL and does not produce distinct loculations.
- C. Punched-out lesions are discrete, rounded, non-corticated lucencies scattered through the skeleton — the hallmark of multiple myeloma, and again a disease of adults.
- D. CORRECT. MULTILOCULAR — expansile radiolucencies subdivided by bony septa, often described as soap-bubble. In cherubism this appears BILATERALLY and SYMMETRICALLY, most often in the posterior mandible and mandibular angles, and may extend to the maxillary tuberosities.