EURORAD ESR

Case 16064

Tertiary Hyperparathyroidism in X-linked Hypophosphatemic Rickets

Author(s)
Nuno Pereira da Silva, Manuel Cruz, João Macedo, Ana Aguiar Ferreira, Fernanda Cruz, Paulo Donato

Centro Hospitalar e Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Medical Imaging Department; Praceta Prof. Mota Pinto 3000-075 Coimbra, Portugal; Email:nunoapsilva22@gmail.com
 
Patient
female, 34 year(s)
 
 
  • Figure 1
    Frontal radiographs of lower limbs
     

    Partially corrected varus deformity. A brown tumour is also apparent in the lower metaphysis of the left femur (arrow).

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;

    Severe deformities in the tibial and peroneal bones due to insufficiency fractures. Healed Looser zones are also visible as transverse dense lines.

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;
     
     
  • Figure 2
    Plain radiograph of thorax

    Bulging of the anterior rib in the costochondral junctions (arrows) - "Rachitic Rosary".

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;
     
     
  • Figure 3
    Frontal radiographs of upper limbs
     

    Front radiograph of the right arm reveals exuberant osteolytic, expansive lesions occupying most of the upper portion of the humerus, "brown tumours" (dotted line).

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;

    Front radiograph of the right forearm. Similar osteolytic, expansive lesions are visible on the radium (dotted line) and the proximal phalanx of the index finger (arrow).

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;

    Front radiograph of the left arm. Thought not as exuberant as the lesions on the right, "brown tumours" can be observed in the proximal and distal humerus and the clavicle (arrows).

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;

    Front radiograph of the left forearm. A "brown tumour" is observed in the distal radius (arrows). Bone reabsorption on the radial aspect of the second and third middle phalanges is visible, pathognomonic of...

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;

    Detail view of bone reabsorption on the radial aspect phalanges (arrows).

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;
     
     
  • Figure 4
    Lateral Skull Radiograph

    Multiple millimetric "punched-out" lesions in the calvaria are observed, the "Salt-and-pepper" sign. Widening of diploe is also visible.

     
    Area of Interest: Bones; Head and neck; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;
     
     
  • Figure 5
    Lateral radiograph of lumbar spine

    Sclerotic bands in the endplates of the vertebra - "rugger jersey" spine.

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;
     
     
  • Figure 6
    Cervical ultrasound

    Posterior to the left thyroid lobe there is a oval, solid, hypoechoic nodule corresponding to a parathyroid adenoma.

     
    Area of Interest: Thyroid / Parathyroids; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;
     
     
  • Figure 7
    Plain radiograph after

    One year after the parathyroidectomy the lesions have decreased in size and are less lucent.

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Endocrine disorders;
     
     
Partially corrected varus deformity. A brown tumour is also apparent in the lower metaphysis of the left femur (arrow).
 
Severe deformities in the tibial and peroneal bones due to insufficiency fractures. Healed Looser zones are also visible as transverse dense lines.
 
Bulging of the anterior rib in the costochondral junctions (arrows) - "Rachitic Rosary".
 
Front radiograph of the right arm reveals exuberant osteolytic, expansive lesions occupying most of the upper portion of the humerus, "brown tumours" (dotted line).
 
Front radiograph of the right forearm. Similar osteolytic, expansive lesions are visible on the radium (dotted line) and the proximal phalanx of the index finger (arrow).
 
Front radiograph of the left arm. Thought not as exuberant as the lesions on the right, "brown tumours" can be observed in the proximal and distal humerus and the clavicle (arrows).
 
Front radiograph of the left forearm. A "brown tumour" is observed in the distal radius (arrows). Bone reabsorption on the radial aspect of the second and third middle phalanges is visible, pathognomonic of hyperparathyroidism.
 
Detail view of bone reabsorption on the radial aspect phalanges (arrows).
 
Multiple millimetric "punched-out" lesions in the calvaria are observed, the "Salt-and-pepper" sign. Widening of diploe is also visible.
 
Sclerotic bands in the endplates of the vertebra - "rugger jersey" spine.
 
Posterior to the left thyroid lobe there is a oval, solid, hypoechoic nodule corresponding to a parathyroid adenoma.
 
One year after the parathyroidectomy the lesions have decreased in size and are less lucent.
 
 
 
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