Osteopoikilosis: spotted bones

Osteopoikilosis is a rare, benign sclerosing bone dysplasia characterized by multiple, symmetric, well-defined sclerotic lesions primarily located in the epiphyseal and metaphyseal regions of long bones, pelvis, and hands. Although usually asymptomatic and incidentally discovered, its radiographic appearance may mimic osteoblastic metastases, leading to diagnostic confusion. Accurate recognition of imaging features is essential to avoid unnecessary invasive procedures and to provide appropriate patient reassurance.