CASE 156
BY: Dr. NIZAR AL-NAKSHABANDI MD, FRCPC
HISTORY: Withheld.
FINDINGS:
The AP [A] and oblique [B] views of the hands demonstrate bilateral terminal tuft resorption.
There is no evidence of erosions seen. No evidence of soft tissue calcification. No joint destruction is seen.
DIAGNOSIS:
Acro-osteolysis.
PEARLS AND DISCUSSION:
Acro-osteolysis is tuft resorption or resorption of the distal phalanges. It can also affect the shaft of the distal phalanx as sub-periosteal resorption.
When the terminal tuft is resorbed, the differential is usually of scleroderma, psoriasis, and thermal injury [if it is cold, then it is frostbite, and if it is from heat, then it is from burns or electricity], and dermatomyositis can cause it as can reactive arthritis and juvenile chronic arthritis.
If it is the mid shaft that is resorbed, then toxicity is from poly vinyl chloride exposure, hyperparathyroidism [look for Brown tumors in that case] or the rare Hajdu-Cheney syndrome.
Single-digit acrolysis can occur in trauma cases, glomus tumor of the digit, or epidermoid inclusion tests cyst.
Metastasis from bronchogenic cancer can give the cookie bite appearance of the terminal tuft. Osteomyelitis can cause tuft resorption as well.
FURTHER READING:
1. Miller TT. Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology. 2008;246 (3): 662-74
2. Avouac J, Guerini H, Wipff J et-al. Radiological hand involvement in systemic sclerosis. Ann. Rheum. Dis. 2006;65 (8): 1088-92.
3. Davies S (editor). Chapman & Nakielny's Aids to Radiological Differential Diagnosis: Expert Consult - Online and Print, 6e. Saunders Ltd
