Presentation
Chronic renal failure.
Patient Data
Age: Adult
From the case:
Renal osteodystrophy and brown tumors
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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