CTICasesBrown Tumors of Secondary Hyperparathyroidism
Imaging findings
Chest CT demonstrates multiple expansile, lytic skeletal lesions within the ribs, clavicles, and vertebral bodies, mimicking aggressive metastatic disease or lymphoma. Additional findings include absent kidneys (indicative of prior bilateral nephrectomy or severe renal failure) and a classic 'rugger-jersey spine' pattern characterized by dense, band-like sclerosis of the vertebral body endplates. Sestamibi SPECT and ultrasound demonstrate four dramatically enlarged parathyroid glands. Biopsy of the chest wall lesions confirmed brown tumors of hyperparathyroidism.
Key takeaways
Brown tumors are non-neoplastic, highly vascular reactive bone lesions caused by intense osteoclast activity in patients with severe hyperparathyroidism, typically secondary to chronic renal failure. Because they present as lytic, expansile, FDG-avid skeletal lesions, they can easily be misdiagnosed as metastatic disease or lymphoma. Recognizing the hallmarks of renal osteodystrophy (such as a rugger-jersey spine) and identifying a highly elevated parathyroid hormone (PTH) level are vital to avoiding diagnostic errors and unnecessary interventions.
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