Figure 3.

Standard Skeletal Radiography images: (A) Left lower arrow, sub periosteal resorption of the distal phalanx of the middle finger, and at the intermediate phalanx of the index finger as indicated by the right upper arrow in a hemodialysis patient, virtually pathognomonic of severe secondary hyperparathyroidism. (B) Image of a “brown tumor” at the distal radius metaphyseal as indicated by the arrow. It is a well-limited lytic lesion with endosteal scalloping, one of the possible manifestations of severe secondary hyperparathyroidism. (C) Periarticular calcifications of the glenohumeral ligaments, appearing as cloud-like densities that diffuse into the adjacent tenosynovial tissues. (D) “Salt and pepper” aspect of the calvaria seen as well-defined lucencies suggesting bone resorption. (E) Lateral spine X-ray can be used to assess vertebral fracture in a hemodialysis patient. (F) Multiple oblique spiral fractures in the proximal, middle and distal third of the humerus in a hemodialysis patient with osteomalacia.