Plain radiograpic appearance of the cranium
The patient was examined by conventional radiography. Lateral plain radiography of the skull showed prominent sclerosis at the skull base. Frontal bossing was seen. The mandible was hypoplastic (Fig. 1). Plain radiography of the extremities and columna vertebralis revealed diffuse osteosclerosis and bone expansion at the metaphyseal regions of the tubular bones (Fig. 2a). There were horizontal and transverse radiolucent lines in the metaphyses of long bones. Anteroposterior radiography of the columna vertebralis, ribs, clavicles and pelvis showed the vertebrae to be markedly increased in density. The pelvic bones were also sclerotic and showed bone within bone appearances (Fig. 2b).
Radiographic findings include generalised osteosclerosis (2). Metaphyseal modelling is only mildly abnormal, and the medullary cavities may be narrowed. The bones of the hands and feet are short, with osteolysis of the distal phalanges. In the skull, a marked delay in closure of the sutures is evident. Wormian bones are common. A thick and sclerotic skull base is also seen. The vertebral bodies are sclerotic, and errors in vertebral segmentation may be present. Osteopetrosis and dysosteosclerosis should be taken into consideration in differential diagnosis.
 1. Bathi RJ, Masur VN. Pyknodysostosis a report of two cases with a brief view of the literature. Int J oral Maxillofac Surg 2000;29:439-42. (PMID: 10715719)
 2. Jacobson HG. Dense bone too much bone: radiological considerations and differential diagnosis. Part II. Skeletal Radiol 1985;13:97-113. (PMID: 3883506)