Idiopathic osteosclerosis (IO) typically manifests as an incidentally discovered, well-defined homogenous radiopacity that blends in with the surrounding bone. Once the condition is diagnosed, treatment is neither indicated nor necessary; however, atypical variants of osteosclerosis have been described and may pose a diagnostic and management dilemma for the clinician who encounters them. This case report discusses the differential conditions that should be considered when an atypical variant of IO is encountered. While the diagnosis in this case was fortuitously confirmed by biopsy, routine follow-up is the recommended course of action.
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