CTICasesRenal Osteodystrophy
Imaging findings
Chest radiographs and bone-window CT in a patient with chronic renal failure on hemodialysis demonstrate cardiomegaly, vascular distension, and severe, symmetrical subperiosteal bone resorption of the clavicles. The cortical margins of the distal clavicles are fuzzed, eroded, and indistinct, presenting a 'paintbrush' appearance, with loss of the corticomedullary junction. A large, expansile lytic bone lesion is present in a rib (representing a Brown tumor).
Key takeaways
Renal osteodystrophy is a complex bone disorder associated with chronic kidney disease, driven by secondary hyperparathyroidism. A classic radiographic hallmark is subperiosteal bone resorption, which characteristically involves the distal ends of the clavicles, the hands, and ribs. It can lead to focal osteolytic lesions known as Brown tumors (osteoclastomas) that can mimic primary bone malignancies.
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