Medical Imaging Analysis Report

I. Radiological Findings

Based on the provided X-ray images (both hands, both knees, pelvis, etc.), as well as bone scan and CT imaging, the following main features are noted:

• Pelvis and proximal femur: Local abnormal density changes, showing both osteolytic lesions and relatively sclerotic areas (seen in upper and lower parts of the pelvic structure), indicating active bone turnover.
• Hand X-ray: Phalanges and other regions display varying degrees of bone resorption or cystic lesions, with some areas appearing as “lucent zones” or demonstrating osteopenia and destruction.
• Knee X-ray: Overall reduced bone density with focal bone changes that have relatively clear boundaries; local cortical bone thinning is also observed.
• Bone scan: Lesions with increased radionuclide uptake, suggesting active bone metabolism.
• CT findings: Well-defined low-density areas indicating osteolytic changes; some regions show relatively high density due to repair or sclerosis.

Combining the patient’s bone pain, proximal muscle weakness, polydipsia, and polyuria, the above radiological findings suggest a systemic abnormality of bone turnover. Multiple bone sites showing “active” lesions indicate that a metabolic or endocrine disorder could be responsible for these changes.

II. Potential Diagnoses

Based on imaging characteristics and clinical findings, the main differential diagnoses include:

1. Primary Hyperparathyroidism (with Multiple Brown Tumors)
   • Characteristics: Can lead to hypercalcemia, bone pain, muscle weakness, and polyuria/polydipsia. “Brown tumors” are reactive lesions caused by increased osteoclastic activity.
   • Imaging: Osteolytic or mixed changes involving multiple skeletal sites, possibly presenting with bone cysts and “sclerotic” or reparative changes.
2. Multiple Myeloma
   • Characteristics: Bone pain, osteolytic lesions, abnormal protein electrophoresis.
   • However, this patient’s hypercalcemia and accompanying polyuria/polydipsia are more suggestive of parathyroid dysfunction (elevated PTH) rather than multiple myeloma.
3. Metastatic Bone Tumors
   • Characteristics: May present with multiple osteolytic or sclerotic lesions.
   • This patient’s elevated serum calcium and PTH levels indicate an endocrine-related pathology, and there is no clear evidence of a primary malignant tumor.

III. Final Diagnosis

Considering the patient’s age, symptoms (bone pain, polyuria, polydipsia, muscle weakness), radiological findings (multiple osteolytic or sclerotic lesions), and laboratory data (elevated serum calcium and PTH), the most likely diagnosis is:

Primary Hyperparathyroidism with Multiple Brown Tumors.

If uncertainty persists, a bone biopsy and further imaging of the parathyroid glands (e.g., ultrasound, CT, or radionuclide scans) can help confirm the cause and rule out malignancy.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy
   • If a parathyroid adenoma is identified, surgical removal may be indicated to correct the endocrine imbalance.
   • Manage hypercalcemia with pharmacotherapy such as bisphosphonates, intravenous hydration, or diuretics (under medical supervision).
   • Assess fracture risk to determine the need for vitamin D, calcium modulators, or other bone-protective agents, while regularly monitoring laboratory values.
   • Regular follow-up of serum calcium, PTH, and renal function to evaluate treatment effectiveness and prevent complications.
2. Rehabilitation and Exercise Prescription
   • Until bone lesions stabilize, high-impact or high-intensity exercises should be avoided to reduce fracture risk and further damage.
   • Initially engage in low-intensity activities (e.g., walking, gentle cycling, or supervised water exercises). Limit each session (e.g., 10–15 minutes per day) and progressively extend to 30 minutes as tolerated.
   • Once serum calcium levels and bone integrity improve, introduce muscle-strengthening exercises with low-resistance loads and core training, while monitoring for deepening pain or fatigue.
   • FITT-VP principle:
     • Frequency: Begin at 3–5 sessions per week, starting with lower frequency.
     • Intensity: Low to moderate intensity, maintaining a safe heart rate.
     • Time: Gradually increase session duration, continually assessing skeletal response.
     • Type: Combine aerobic activities (e.g., walking, swimming) with mild resistance training.
     • Progression: Increase volume every 2–4 weeks according to tolerance.
     • Volume and Pattern: Adjust total exercise load and rest periods individually to avoid excessive fatigue.
   • If the patient has severely weakened bones, unstable joints, or decreased cardiopulmonary function, an individualized rehabilitation program under the supervision of a therapist or specialist is strongly recommended to ensure safety.

V. Disclaimer

This report represents a reference medical analysis based on the currently available information and does not replace in-person consultation or professional medical advice. The specific treatment plan should be individually determined by a clinical physician combining these findings with the patient’s actual condition.