This 50 year old gentleman is known to have chronic renal failure, was admitted to our hospital for permcath insertion to undergo dialysis. Initially his physician in charge requested thyroid ultrasound which showed hyperplastic parathyroid glands due to his condition of long standing hypocalcemia. Chest x-ray was done after permcath insertion, and demonstrated subchondral resorption of the lateral  clavicles with no evidence of pneumothorax. X-ray of the skull and both wrists were also done depicting multiple tiny lucent skull vault lesions, soft tissue calcifications, bone demineralization, rib notching and acro-osteolysis all these findings due to secondary hyperparathyroidism.