Findings

Her physician suspected renal osteodystrophy and obtained a bone scintigram. This demonstrated diffuse uptake throughout the skeleton, particularly the skull, with little renal uptake and minimal bladder activity ("superscan"). Radiographs revealed some resorption of the distal clavicles (arrows) and diffuse granularity of the calvarium with indistinct outer cortex, vascular grooves and sella. These findings are diagnostic of hyperparathyroidism, confirming the impression of renal osteodystrophy. Appropriate therapy was begun.

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J. Anthony Parker, MD PhD, jap@nucmed.bih.harvard.edu