Bone within a bone

Case contributed by Yaïr Glick


Premature infant with hyperparathyroidism.

Patient Data

Age: 4-18 months
Gender: Male

Age 4m5d


NGT tip projected on stomach.
Bronchopulmonary dysplasia.
Rachitic rosary.

Age 4m27d


Bone within a bone appearance, most obvious in the long bones of the upper and lower limbs.

Age 5m18d


Bone within a bone appearance in the arms better appreciated on this X ray, taken 3 weeks after the previous one.

Age 18 months


In this chest X ray, taken about a year after the previous one, bone density appears normal and there are no signs of altered bone metabolism, which has long since normalized.

Case Discussion

Born via vaginal delivery at 23 weeks + 6 days' gestation (very early premature). Among the abundance of problems associated with early prematurity, he was diagnosed with osteopenia of prematurity. Hyperparathyroidism was discovered. Received treatment which included a supplement of calcium, phosphorus, vitamin D and alpha-D3, as well as bicarbonate. All values gradually normalized, after which bicarbonate and alpha-D3 were discontinued.

Renal ultrasound (not shown), repeated several times during the infant's prolonged stay at the NICU, did not show nephrocalcinosis.

This case demonstrates a transient state of "bone within a bone" after commencing treatment for secondary hyperparathyroidism.

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