Musculoskeletal

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63 year old, Right hip pain
Spot Image
DDX, Additional Images Recommended?
Additional Image
Findings? Dose this change your DDx?

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Additional Image
Findings, Dx?
Additional Image
Does this Confirm your Dx?

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Additional Images, different patient
How are these images related to the disease process?
Answers
Brown Tumor / Hyperparathyroidism

Initial radiographs showed a central, non-aggressive lytic lesion that contains no visible matrix. In a 63 year old patient, without any other hints, you might consider metastatic thyroid disease, a solitary bone cyst, or chondromyxoid fibroma
Subsequent images, in order of appearance, showed a “salt & pepper”, skull, resorption of the distal clavicle, and finally hand films with subperiosteal bone resorption of the distal clavicle, and finally hand image with subperiosteal bone resorption. All are consistent with hyperparathyroidism, which makes Brown Tumor the best diagnosis
Finally 2 images showed “Rugger Jersey Spine” and a “Looser Zone”


Hyperparathyroidism Information

Primary
Hyperparathyroidism due to autonomously functioning parathyroid gland [e.g., adenoma]
Secondary hyperparathyroidism is a physiologic response to calcium loss [renal osteodystrophy, calcium deprivation, elevated serum phosphatase]
Laboratory Findings in Hyperparathyroidism: Elevated parathyroid hormone (in 100%), alkaline phospatase (50%)
Radiological findings: Bone Resorption – subperiosteal resorption is pathognomonic also, subchondral, cortical, trabecular, and subligamentous resorption
Brown tumors (osteoclastomas) more frequently seen in primary hyperparathyroidism
Osteosclerosis and soft-tissue calcifications more commonly seen in secondary hyperparathyroidism
Renal stones / nephrocalcinosis seen in up to 70%

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