A 37-year-old man with McCune-Albright Syndrome and a past history of partial rib resection (9th and 11th left ribs) was admitted to our institution with pain in the left femur and in multiple ribs. He had no history of trauma. The patient underwent a technetium-99m-methylene diphosphonate (99mTcTc-MDP) bone scan. Planar whole-body images acquired 3 hours after injection in anterior and posterior views revealed intense tracer uptake in the pars orbitalis of the frontal bone, left sphenoid wing, nasal bones, zygomatics, maxillae, left temporal bone, and occipital bone. Increased uptake was also noted in several ribs bilaterally (1st, 3rd, 8th, 9th, 11th left ribs; 8th, 12th right rib) and in the left proximal femoral shaft. These findings were compatible with polyostotic fibrous dysplasia. Fibrous dysplasia involving the sphenoid wing has been described as the pirate sign as it resembles a pirate wearing an eye patch.

McCune-Albright syndrome is a rare congenital sporadic disorder characterized by bone fibrous dysplasia, endocrine disorders, and café-au-lait skin pigmentation.¹ Fibrous dysplasia can affect one bone (monostotic form), or multiple bones (polyostotic form).² This case illustrates the usefulness of 99mTcTc-MDP bone scan, a sensitive and relative low-cost examination of the whole body,³ in defining the extent of bone involvement by fibrous dysplasia, particularly in asymptomatic regions(Fig. 1).