CTICasesRenal Osteodystrophy with Brown Tumors and Pathologic Rib Fracture
Imaging findings
A second patient with the same underlying condition shows a more striking rugger-jersey spine, together with large lucent spaces representing osteoclastic bone resorption that qualify as brown tumors, and areas of apparent cortical destruction. Similar destructive change is present in the sacrum. A rib is expanded and enlarged, most consistent with a brown tumor that has sustained a pathologic fracture; no CT was available to characterise the rib lesion further.
Key takeaways
Renal osteodystrophy spans a spectrum, and in its more advanced form the lucencies of osteoclastic resorption become frank brown tumors with cortical destruction. An expanded, enlarged rib in this setting should raise the possibility of a brown tumor with pathologic fracture rather than a primary bone neoplasm. Seeing two patients side by side demonstrates the range, from subtle cortical blurring to overt bone destruction.
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