CTICasesRenal Osteodystrophy with Reversible Cardiomegaly and Distal Clavicular Erosion
Imaging findings
One chest radiograph shows cardiomegaly with distended upper-zone vessels, mild pulmonary oedema fuzzing the vessels, and slight fissural thickening. A second radiograph of the same patient at a different time shows the heart smaller, vascular calibre reduced, and the oedema and fissural thickening resolved. The spine shows a rugger-jersey pattern with a central lucent band and denser than normal bone above and below, the medullary density blurring the boundary against cortical bone so that the vertebral bodies resemble a stack of marshmallows rather than a stack of picture frames. At the distal clavicle the cortex is initially only slightly indistinct, but on later imaging there is frank erosion at the inferior ligamentous attachment, with loss of a sharp cortical envelope bilaterally while the acromion remains well defined.
Key takeaways
Failing kidneys leave a patient susceptible to volume overload, so cardiomegaly and oedema in renal osteodystrophy can be strikingly reversible between studies. Two skeletal signs are visible on the chest radiograph itself: rugger-jersey spine, where loss of the crisp cortical borders top and bottom gives vertebral bodies a marshmallow appearance, and distal clavicular resorption. Distal clavicular erosion is not specific — it is also seen in rheumatoid arthritis — but combined with the spine findings it points to hyperparathyroidism. Renal osteodystrophy is encountered less often now that nephrologists manage calcium and bone health better and patients are transplanted earlier.
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