Answer for CoW 27 Aug 2017
Tuberculous dactilitis
Findings
Expansile lytic lesion in the head of the second metacarpal bone.
Discussion
Tuberculous dactylitis, also known as spina ventosa, is a rare skeletal manifestation of tuberculosis where the short tubular bones are affected. The term spina ventosa derives from "spina" meaning "short bone" and "ventosa" meaning "expanded with air". Tuberculous osteitis is one of the commonest bacterial osteitis. Typically the dactylitis form affects paediatric age group more often than adults. In children multiple or consecutive bones are involved, compared to a single bone in adults. Tuberculous dactylitis involves the short tubular bones of the hands and feet in children. It often follows a benign course without pyrexia and acute inflammatory signs as opposed to acute osteomyelitis. Plain radiograph Plain radiography is the modality of choice for evaluation and follow-up. The bones distal to tarsus and wrist tend to be affected, with the upper limb being more commonly involved. Typically the proximal phalanx of the index/middle fingers and middle/ring finger metacarpals are affected. Characteristic features include: involved bone shows a diaphyseal expansile lesion periosteal reaction is uncommon healing is by sclerosis, which is usually gradual Differential diagnosis:
Pyogenic or fungal infections syphilitic dactylitis sarcoidosis haemoglobinopathies hyperparathyroidism leukemia.
Findings
Expansile lytic lesion in the head of the second metacarpal bone.
Discussion
Tuberculous dactylitis, also known as spina ventosa, is a rare skeletal manifestation of tuberculosis where the short tubular bones are affected. The term spina ventosa derives from "spina" meaning "short bone" and "ventosa" meaning "expanded with air". Tuberculous osteitis is one of the commonest bacterial osteitis. Typically the dactylitis form affects paediatric age group more often than adults. In children multiple or consecutive bones are involved, compared to a single bone in adults. Tuberculous dactylitis involves the short tubular bones of the hands and feet in children. It often follows a benign course without pyrexia and acute inflammatory signs as opposed to acute osteomyelitis. Plain radiograph Plain radiography is the modality of choice for evaluation and follow-up. The bones distal to tarsus and wrist tend to be affected, with the upper limb being more commonly involved. Typically the proximal phalanx of the index/middle fingers and middle/ring finger metacarpals are affected. Characteristic features include: involved bone shows a diaphyseal expansile lesion periosteal reaction is uncommon healing is by sclerosis, which is usually gradual Differential diagnosis:
Pyogenic or fungal infections syphilitic dactylitis sarcoidosis haemoglobinopathies hyperparathyroidism leukemia.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!