You are correct. Skull x-ray showed moth-eaten appearance suggestive of Paget dz of bone; the dx was confirmed by nuclear med scan. “Scalp vein sign” has been described in many pts w/ Paget dz w/ skull involvement. Conditions that could mimic this sign include giant cell arteritis and metastases of follicular thyroid carcinoma, wherein the arteries become more prominent and tender. This pt was treated w/ IV zoledronic acid, and supplementation of calcium and vit D. Serum alk phos normalized at 6mo, although hearing and scalp vein distension did not improve significantly.

BMJ Case Reports 2017; doi:10.1136/bcr-2017-220259