Anterior and posterior whole-body and arm spot views from a bone scan demonstrate diffusely increased cortical/periosteal linear uptake involving the upper and lower extremities symmetrically (arrows). The femora, tibiae, fibulae, humeri, radii, ulnae, and metatarsals are all involved.

Differential Diagnosis

•  Hypertrophic osteoarthropathy (HOA): Diffuse, symmetric “tram tracking” appearance along the periosteal surfaces of the extremities makes this the most likely diagnosis.

•  Shin splints: These will also have linear periosteal uptake of the lower extremities but will be confined to the mid-to-distal tibiae and will not affect the upper extremities.

•  Paget disease: