PMC5123767_01
Radiological findings in the reported patient.. Notes: (A) Skull radiograph demonstrates trabecular bone resorption that resulted in a salt-and-pepper appearance of the calvarium. (B) Pelvic radiograph demonstrates resorption of the subcapital region of the femoral neck with subsequent fracture, leading to SCFE, bilaterally. (C) Bilateral radiograph of the hands shows subperiosteal bone resorption at the distal radius and ulna; there is greater right-side involvement. There is a well-defined lytic lesion involving the left third metacarpal bone measuring 3.5 cm x 1 cm with no cortical breakthrough, along with a similar, but smaller, lytic lesion involving the right fifth metacarpal bone, representing a brown tumor. (D) Ultrasound of the right parathyroid shows a well-defined hypoechoic hypervascular nodule that measures approximately 3.0 cm x 1.7 cm x 1.2 cm; it can be seen posteriorly in relation to the lower pole of the right lobe of the thyroid. It likely represents an enlarged parathyroid gland. (E) 99mTc-Tetrofosmin dual-phase parathyroid scintigraphy illustrates increased focal tracer uptake projecting to the lower part of the right thyroid lobe; this shows early uptake with delayed washout, compatible with the features of a parathyroid adenoma. (F) Pelvic radiograph demonstrates bilateral SCFE postfixation and pinning.
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Skeletal imaging showed findings suggestive of bone resorption of skull, pelvis, and hands (Fig. 1A-C). The ultrasound of the patient's parathyroid showed a well-defined parathyroid adenoma measuring 3.0 cm x 1.7 cm x 1.2 cm (Fig. 1D). Later, a dual-phase parathyroid scan revealed increased focal tracer uptake projecting to the right lower lobe of the thyroid gland, where early tracer uptake and delayed washout were noted, compatible with a parathyroid adenoma (Fig. 1E). Nine days after the parathyroidectomy, the patient underwent bilateral femoral head pinning in situ with immobilization and rest for 6 weeks (Fig. 1F).