Secondary hyperparathyroidism (2 HPT), characterized by high turnover bone disease and hyperplasia of the parathyroid gland (PTG) is a common complication in chronic dialysis (CD) patients Supplementation with vitamin D analogues and management of phosphate retention by phosphate binders and hypocalcemia by calcium supplementation, are useful modalities to suppress serum parathyroid hormone (PTH) secretion and to prevent parathyroid enlargement Unfortunately Part of these interventions appear to increase the risk of tissue and vascular calcification in patients with ESRD, that may contribute to the development of cardiovascular disease. It is particularly difficult to control 2HPT, even with vitamin D pulse therapy , when one or more PTGs progress to the nodular hyperplasia stage .Ultrasonography can differentiate between diffuse and nodular hyperplasia of parathyroid gland according to the size of the gland. Recently, selective percutaneous ethanol or vitamin D injection therapy has been used to control parathyroid function in patients with 2HPT prior to parathyriodectomy.