Snapshot!

Smiley face

This computed tomography (CT) scan shows a "smiley face" on the first sacral vertebra of an 80-year-old man with sclerotic vertebrae resulting from extensive prostate metastases.

The patient had his prostate cancer diagnosed in 1993, and was initially treated with zoladex and androcur. Bone metastases were detected in 1998 and palliative therapies over the past two years have included various analgesics, localised external beam radiotherapy to the lumbar spine and sacrum, and strontium (⁸⁹Sr) treatment. When this CT scan was taken he was taking morphine (20 mg twice daily), and was free of pain most of the time. His bone scan showed extensive diffuse uptake throughout the skeleton, and his prostate-specific antigen level was 4400 micrograms/L (normal range, <4 micrograms/L).

Malcolm Feigen
Radiology Registrar
The New Children's Hospital, Westmead, NSW

©MJA 1999
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