Presentation
Left maxillary and mandibular swelling. Referred from dental clinic.
Patient Data
Diffuse expansion of the maxillary and mandibular bones showing cortical thinning, dense trabeculae, and serpiginous lucencies/tunnels (feline stripes) within the bone marrow. Also a focal asymmetric left maxillary and mandibular bone swelling showing the zonal pattern with alternating hypodense and hyperdense rings
Other features of renal osteodystrophy include:
diffuse calvarial thickening with widened diploic space, cortical resorption, and salt and pepper appearance
vertebral osteomalacia
mild erosive changes of both temporomandibular joints
Focal asymmetric left maxillary and mandibular bone swelling s (arrows) showing alternating hypoattenuation and hyperattenuation rings giving the zonal pattern.
Case Discussion
The patient was known to have chronic renal failure on hemodialysis. He had a history of progressive facial swelling with current right hard palatal hard swelling.
Uremic leontiasis ossea is a rare condition that occurs in patients with renal failure on hemodialysis with secondary hyperparathyroidism. It is characterized by swelling of the jaws, widening of the nares, flattened nasal bridge, and increased interdental spacing.
Radiographic features include:
-
radiological criteria of renal osteodystrophy and secondary hyperparathyroidism
skull thickening with salt and pepper appearance
-
diffuse maxillary and mandibular expansion with:
characteristic intramedullary serpiginous tunnels (feline stripes), or
zonal pattern which is characterized by alternating hypoattenuation and hyperattenuation rings caused by osteoclastic activity (lytic lesions) and osteoblastic activity (sclerosis) respectively
focal asymettric maxillary or mandibular bone swellings
Unable to process the form. Check for errors and try again.