History: altered mental status
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Very thickened inner and outer cortices. Patchy lytic and “fluffy” blastic medullary appearance - aka “cotton wool” appearance.
Answer: Classic appearance of Paget’s Disease of the skull .
Paget’s ref: http://radiopaedia.org/articles/pagets-disease-of-bone-1
If you see cortical thickening and bony expansion diffusely of an area of bone, Paget’s is upper there on the differential