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In Paget's disease of bone, one of the hallmark clinical findings is the presence of cotton wool opacities on radiographic images. These opacities represent areas of abnormal bone remodeling and are a result of the disease's characteristic disorganized bone formation and resorption processes. As Paget's disease progresses, the affected bones undergo changes that lead to thickening and expanding of the bones, which can appear as fluffy or cotton-like on X-rays.

The presence of cotton wool opacities is significant because it indicates the presence of pathological alterations in the bone structure due to this condition. This finding can often be seen in the skull, but it may also present in other skeletal areas affected by the disease.

In contrast, other findings related to Paget's disease, such as osteolytic lesions and osteosclerotic lesions, can also occur but do not characterize the condition in the same way. Osteolytic lesions refer to areas of bone loss, whereas osteosclerotic lesions describe regions of increased bone density. While both of these can happen in Paget's disease, the quintessential and visually distinctive cotton wool opacities are what primarily align with its clinical presentation. A normal trabecular pattern would not be expected in Paget's