Presentation
Known ESRD for 7 years with biochemically proven hyperparathyroidism.
Patient Data
Distal phalanx midshaft resorption involving both first and second fingers.
Subtle subperiosteal bone resorption involving the radial aspect of the middle phalanx of bilateral second fingers.
Calcification at the arteriovenous fistula at the radial aspect of the left wrist.
Case Discussion
There are only three usual differentials for midshaft acro-osteolysis:
- hyperparathyroidism
- Hajdu-Cheney syndrome
- polyvinylchloride exposure
The constellation of findings of acro-osteolysis, subperiosteal bone resorption at the radial aspect of the second middle phalanx and calcification at the left arteriovenous fistula is classical of hyperparathyroidism secondary to end-stage renal failure, and is commonly encountered in radiology exams.
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