# Imaging features of a brown tumor with extensive skull involvement: Relevance for dental radiology

## TL;DR

A rare brown tumor was found in a kidney disease patient during a CT scan for sinusitis, highlighting the importance of imaging and teamwork in managing complex cases.

## Contribution

This case emphasizes the role of CT in detecting incidental skeletal changes and the value of interdisciplinary care in systemically compromised patients.

## Key findings

- CT and MRI revealed a brown tumor in the sphenoid and frontal sinuses with no symptoms.
- Five-year follow-up showed no significant changes in the lesion after conservative treatment.
- Renal transplant improved the patient's bone disease and quality of life.

## Abstract

This case report describes a rare, asymptomatic brown tumor in a patient with end-stage renal disease. The lesion was incidentally detected during a computed tomography (CT) scan of the paranasal sinuses, performed upon a dentist’s recommendation to investigate maxillary sinusitis. CT imaging revealed an expansive osteolytic lesion with irregular margins and a ground-glass appearance involving the left side of the sphenoid and frontal sinuses. Subsequent magnetic resonance imaging (MRI) with multiplanar T1 and T2-weighted sequences without contrast demonstrated a solid tissue-like expansive lesion affecting the left frontal and sphenoid bones, mildly compressing adjacent cerebral parenchyma. Despite these findings, the patient remained asymptomatic. Conservative management, including pharmacological therapy with calcimimetics to control parathyroid hormone levels, was initiated. A follow-up MRI after five years showed lesion stability without significant changes. The patient later underwent a renal transplant, which effectively stabilized the bone disease and improved his quality of life. This case underscores the pivotal role of computed tomography (CT) in detecting incidental systemic skeletal changes and the indispensable importance of interdisciplinary collaboration in managing complex conditions in systemically compromised patients, where each professional’s expertise is crucial for the patient’s well-being.

Key words:Sinusitis, Brown Tumor, Hyperparathyroidism, Multidetector Computed Tomography, Magnetic Resonance Imaging, Multidisciplinary Care Teams.