Presentation
Known to have end-stage renal disease and hyperparathyroidism.
Patient Data
Chest x-ray shows a deformed chest wall. The heart appears enlarged, central venous line is inserted. Both lungs and costophrenic angles appear clear. Superior and inferior rib notching more noticeable on the left side.
Subchondral resorption involving distal ends of both clavicles.
Skull x-ray showed thickening of the calvaria with diffuse increased sclerosis and areas of lucency involving skull vault.
Whole spine x-ray showed alternating dense and lucent areas in the thoracolumbar vertebra with a 'rugger jersey spine' appearance.
Pelvis x-ray showed diffuse heterogeneous bone density with evidence of subchondral resorption involving both sacroiliac joints and the symphysis pubis. Lytic lesion surrounded by sclerosis at the right acetabular roof is seen.
Both femora showed multiple small lytic lesions along their shafts.
Impression:
The described findings suggest hyperparathyroidism with a possible Brown tumor in the lower extremities.
There is a rounded hypoechoic lesion less than one centimeter in anteroposterior and mediolateral diameter, located inferior to the left thyroid lobe and lateral to the esophagus, suggestive of parathyroid adenoma.
A smaller lesion suspicious for parathyroid adenoma is seen posterior to right carotid and inferior to the right thyroid lobe.
Subcutaneous soft tissue edema of the neck is noted.
Case Discussion
This case illustrates multiple features of hyperparathyroidism in patient on dialysis secondary to end stage renal disease.
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