LAUSR

increased density are a characteristic radiographic appearance. The main differential diagnosis is osteoblastic metastases, but mastocytosis, tuberous sclerosis, osteopathia striata, melorheostosis, synovial chondromatosis, Paget’s disease, sesamoid ossicles, and Ollier’s disease can be included in the list [7]. Asymmetry, a predilection for axial skeleton involvement, osseous destruction, variation in size, and periosteal reaction are distinguishing features, which are unusual in osteopoikilosis [7]. In most cases, the condition is asymptomatic although some degree of articular pain or joint effusion has been reported in approximately 20% of patients [8]. Osteopoikilosis may be associated with other abnormalities, mostly skin conditions such as a predisposition to keloid formation, scleroderma-like lesions, and discoid lupus erythematosus [8]. Of note, it does not transform to malignancy, bone strength is normal, and no specific treatment or further investigations are required other than patient education and reassurance [8, 9]. Being asymptomatic we did so with our patient. He was discharged home with care for his traumatic injuries. A previously healthy 39-year-old man who was injured in a car crash was admitted to the emergency department. Difficult weight bearing and mild tenderness over his right shoulder, right wrist, and left ankle were notable findings on his trauma survey. Radiologic examination revealed no fractures, but numerous well-defined sclerotic lesions were identified that were compatible with the diagnosis of osteopoikilosis (Fig. 1a–d). Osteopoikilosis: Osteopoikilosis also known as “spotted bone disease or Osteopathia condensans disseminata,” is a sclerosing skeletal dysplasia characterized by multiple bone islands [1, 2] which are small foci of compact bone within cancellous bones. It is a rare disorder incidentally discovered on radiographs. Both sporadic and inherited forms have been reported [3]. The bone islands of osteopoikilosis are 2–10 mm densities of oval or rounded shapes with symmetric distribution in the appendicular skeleton typically clustered around joints [4]. They have a predilection for epiphyses and metaphyses of long bones, carpus, tarsus, and pelvis. The skull is rarely involved, and axial skeleton sparing is a feature [4–6]. Well-defined circular to ovoid spots of