PMC7784083_01
PMC7784083_02
AP radiograph of the left hand, cropped to accentuate osseous detail. Areas of subperiosteal resorption are seen markedly at the radial aspect of the third middle phalanx, and subtly at the radial aspect of the second middle phalanx (arrows). Acro-osteolysis is also evident at the distal phalanges (arrowheads).
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The skeletal changes included periosteal bone resorption and acro-osteolysis of the hands (Figure 1).
Cross-sectional CT of the mandible in bone algorithm at the level of the mandibular angles (A) and symphysis menti (B). There is a loss of cortical and marrow differentiation. This has been replaced by a ground glass density, with areas of irregular osseous expansion (arrowheads in A) and patchy regions of osteosclerosis (asterisk in A). Cystic lesions with wellcircumscribed sclerotic margins (arrows in B) are likely Brown tumours, with evident dental displacement.
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Computed tomography (CT) showed thinning and sclerotic changes in the mandible with multiple lucent areas (Figure 2).
T1 post-gadolinium MRI in midsagittal reconstruction. Calvarial thickening, a known effect of hyperparathyroidism, is apparent (arrowheads). Note the ventricular dilatation and the small posterior fossa (asterisk). Cerebellar tonsillar herniation is depicted (arrow).
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Subsequent magnetic resonance imaging revealed a communicating hydrocephalus and diffuse calvarial thickening with intracortical tunnelling (Figure 3).