Renal osteodystrophy and brown tumors

Case contributed by A.Prof Frank Gaillard

Presentation

Chronic renal failure.

Patient Data

Age: Adult
Annotated image

Plain X-ray hands of a young patient with CRF shows signs of secondary hyperparathyroidism:

  • irregular, frayed and ill-defined cortical outline, pronounced at radial aspect of middle phalanges –> subperiosteal bone resorption
  • multiple lytic expansile lesions –> brown tumors (arrows)
  • osteosclerosis
  • accentuated trabecular pattern non-essential trabeculae are resorbed; those that remain appear prominent)

Case Discussion

Renal osteodystrophy is a constellation of musculoskeletal abnormalities that occur in patients with chronic renal failure.

Manifestations include:

  • osteomalacia (adults) / rickets (children)
  • secondary hyperparathyroidism: bone resorption, osteosclerosis, soft tissue & vascular calcifications and brown tumors
  • aluminum intoxication if the patient is on dialysis

Comment:
Subperiosteal bone resorption is the hallmark of HPTH and is first identified in hands.

Credit:
Dr Ahmed Haroun

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Case information

rID: 36356
Published: 16th May 2015
Last edited: 2nd Mar 2017
Inclusion in quiz mode: Excluded

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