CASE REPORT Unique Imaging Findings in the Facial Bones of Renal Osteodystrophy

SUMMARY: Facial skeletal changes associated with hyperparathyroidism assume 3 radiographic patterns: osteitis fibrosa cystica, fibrous dysplasia, and leontiasis ossea. The 3rd pattern is unique to renal osteodystrophy. We report a case of uremic leontiasis ossea with CT images illustrating significant hypertrophy of the jaws with serpiginous tunneling within the bone and poor visualization of the cortical bone. Although the skeletal changes of hyperparathyroidism arewell documented, they are rarely seen today because the disease is usually diagnosed by laboratory tests before themac-roscopic skeletal abnormalities develop. Among the least com-monly encountered skeletal changes are those that affect the facial bone. The purpose of this report was to illustrate with CT scans an unusual presentation of hyperparathyroidism af-fecting the facial bones, especially the hard palate. Case Report A 37-year-old man with a history of end stage renal disease who was on hemodialysis for 5 years presented with an expanding palatal le