Figure 6. Paget disease of bone in a 64-year-old woman. Lateral radiograph of the distal forearm shows the advancing lytic front typical of the "active" phase of disease (arrowhead) and cortical and trabecular thickening characteristic of the "sclerotic" phase (arrow), as well as bowing and generalized expansile remodeling of the distal radius. Patients with images that showed characteristic features of Paget disease in unusual locations (eg, bones of the upper extremity) occasionally were referred to the Orthopaedic Oncology Clinic with a presumptive diagnosis of neoplasm.