CTICasesBrown Tumors from Renal Osteodystrophy (Secondary Hyperparathyroidism)
Imaging findings
A 43-year-old man with long-standing end-stage renal disease has multiple expansile lytic bone lesions including the right ribs and mid-left clavicle, distal resorption of both distal clavicles at the acromioclavicular joints, and fuzzy, poorly defined vertebral body cortices producing a stacked, rugger-jersey-type appearance, reflecting loss of the sharp cortical-medullary interface.
Key takeaways
In the setting of long-standing renal failure and secondary hyperparathyroidism, these multifocal expansile lesions represent brown tumors rather than metastatic disease, and the transplant team was confident enough in this diagnosis, supported by the classic distal clavicular resorption and osteodystrophy changes, that biopsy was never pursued. The fuzzy stacked-marshmallow vertebral body outline is a recognized sign of renal osteodystrophy distinct from the discrete lytic lesions of the brown tumors themselves.
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