This patient had a long history of chronic renal failure. The plain x-ray of the hand shows typical changes of hyperparathyroidism, with resorption of subperiosteal bone on the radial side of proximal and middle phalanges of the 2nd and 3rd digits. This is most obvious in the proximal phalanx of the middle finger.
Credit: Dr Laughlin Dawes
http://www.radpod.org
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