Hyperparathyroidism x ray

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X Ray

Primary hyperparathyroidism

Finding in primary hyperparathyroidism includes: Subperiosteal bone resorption Classically affects the radial aspects of the proximal and middle phalanges of the 2nd and 3rd fingers Medial aspect of tibia, femur, humerus Phalyngeal tuft erosion (acro-osteolysis) Lamina dura around teeth (floating teeth) Endoosteal bone resorption Widening of medullary cavity Thinning of the inner cortex Subchondral resorption Lateral end of the clavicles Symphysis pubis Sacroiliac joints Subligamentous resorption Ischial tuberosity Humeral tuberosity Trochanters Inferior surface of calcaneus Inferior margin of lateral clavicle Intracortical resorption: cigar/oval-shaped or tunnel-shaped radiolucency in the cortex Osteopaenia Brown tumours Salt and pepper sign in the skull (pepper pot skull) Chondrocalcinosis Secondary and tertiary hyperparathyroidism X-ray is the preferred imaging for diagnosis of secondary hyperparathyroidism as majority of findings are radiological. Findings in secondary and tertiary hyperparathyroidism are often associated with the osteosclerosis of renal osteodystrophy, and the osteomalacia of vitamin D deficiency: Subperiosteal bone resorption Radial aspect of middle phalanges of index and long fingers are involved. Subchondral resorption Hands, hips, shoulders, patellofemoral and sacroiliac joints are involved. Hands are involves in the ulnar side. Distal interphalangeal and metacarpophalangeal joints are involved. Subchondral resorption is very severe. It may lead to bony collapse. Subligamentous resorption Retrocalcaneal bursa and insertion of planter aponeurosis may be involved. Severe osteopenia, may be complicated by pathologic fractures Osteosclerosis, e.g. rugger-jersey spine Brown tumor Amyloid deposition May be manifested as lytic bone lesion on radiograph Soft tissue and vascular calcification Superior and inferior rib notching Osteonecrosis may be often observed in patients in whom steroid is administered for prevention of renal transplant rejection.
Subperiosteal bone resorption - Source:Radiopedia	Brown tumors - Source:Case courtesy of A.Prof Frank Gaillard, Radiopedia
Normal skull compared to Salt & pepper appearance of skull - Source:Radiopedia	Acro-osteolytis, terminal tufts erosion - Source:Case courtesy of Dr Andrew Dixon, Radiopedia