PMC8088473_01
A 42-year-old man with uremic leontiasis ossea presenting with palatal mass. (a) Coronal CT image, bone reconstruction though the face showing marked expansion and marbled appearance of the bone, most prominently involving the maxilla and mandible but also seen involving the frontal bones around the orbit, (b) coronal CT image, bone reconstruction of the face more anteriorly shows marked expansion of the hard palate (white arrows). Note the board disfigurement of palate has the appearance of a lion's face, (c) sagittal CT, bone reconstruction showing prominence of the expanded hard palate visualized on physical exam, (d) 3D CT reconstruction of the bone showing the coarsened appearance of the expanded maxilla and mandible.
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F1
Oral maxillary surgery was consulted and they requested a computed tomography (CT) maxillary face [Figure 1] to be performed for further evaluation.
A 42-year-old man with renal osteodystrophy. (a) Coronal CT abdomen/pelvis with contrast shows bilateral atrophic kidneys containing multiple subcentimeter cysts (white arrows) characteristic of acquired cystic kidney disease in patients undergoing chronic hemodialysis, (b) sagittal CT chest with contrast showing multilevel bands of sclerosis along the endplates of the thoracic vertebrae (solid black arrows) with lucent bone in between, a characteristic appearance of metabolic bone disease in patients with hyperparathyroidism. Note vertebral compression fractures due lost bone mass (dotted black arrows), (c) axial CT of the pelvis showing dense calcification along the iliac arteries and marked osteopenia with loss of the normal medullary trabecular markings in the bones (black dotted arrow). The cutout image shows the appearance of normal trabecular markings (solid black arrow), (d) radiograph of the femur showing a femur fracture also found in our patient. There is angulation of the fracture fragments in the fracture bed. Fracture is a common complication of severe osteopenia.
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F2
A review of CT abdomen [Figure 2a] reveals an atrophic appearance of the kidneys containing multiple small cysts typically seen in patients with end-stage renal disease who are on chronic hemodialysis and atherosclerotic calcification throughout his vasculature. Imaging [Figure 2b-d] also showed decreased bone density in the spine and pelvis and bands of sclerosis along the vertebral endplates, a characteristic feature of metabolic bone disease specific to hyperparathyroidism.