Presentation
Right abdominal pain in end-stage renal disease (ESRD) patient on dialysis with tertiary hyperparathyroidism.
Patient Data
Normal bowel gas distribution.
The chest was scanned without contrast material injection due to a technical fault.
Numerous soft tissue density lytic lesions in most of the imaged bones, some expansile (e.g. posterior arch of the right 9th rib, left ischium). Lesion in T9 posterior arch protruding forward into the spinal canal and severely compressing the thecal sac.
Enlarged cardiac chambers.
Numerous lytic lesions throughout the bony skeleton, exhibiting a mildly high signal on both T1WI and T2WI, some with small cystic components.
Posterior cortical breach with spinal canal compression at heights
Case Discussion
Patient with end-stage renal disease due to dysplastic kidneys, renal osteodystrophy and tertiary hyperparathyroidism presented to the ER with acute-onset right abdominal pain. Lab tests were unremarkable. CT showed many lytic lesions consistent with brown tumors, several of which compressed the spinal cord, most severely especially at the T9 level.
Tumor markers were all negative. Pathology report of a vertebral biopsy came back as "compatible with brown tumor".
Neurological exam was partly abnormal, with a positive Babinsky test.
The patient underwent spinal decompression and fixation and subtotal parathyroidectomy (3 out of 4 glands).
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