CASE 85

By: Dr. Aliya Sarhan Al Barwani.

HISTORY: 5-year-old boy with right hand pain and swelling for 6 weeks.

What are the findings?

What are the differential diagnosis?

FINDINGS:

There is a well define expansile lytic lesion involving the entire 5th metacarpal bone.

It shows endosteal scalloping with trabecular pieces within. The adjacent joints are normal.

DIAGNOSIS:

Chronic osteomyelitis/Tubeculous dactylitis (Spina ventosa).

DIFFERENTIAL DIAGNOSIS:

·        Chronic osteomyelitis/ Tubeculosis dactylitis (Spina ventosa).

·        Enchondroma.

·        Hyperparathyrodism.

PEARLS AND DISCUSSION:

Tuberculous dactylitis is a rare form of extra-pulmonary tuberculosis involving the small bones of the hands and feet. Commonly seen before the age of 6 years. Most of the cases present with no pyrexia or leukocytosis unlike osteomyelitis.

Plain X ray is the modality of choice. It shows a well define expansile lytic lesion with cortical thinning and no periosteal reaction. Clinical history is important to exclude any trips to countries with known TB disease.

FURTHER READING:

1.      De Vuyst D and Vanhoenacker F. Imaging features of musculoskeletal tuberculosis. Eur Radiol. (2003)

2.      S Andronikou and B Smith. "Spina ventosa"—tuberculous dactylitis. BMJ. (2002)

3.      Harisinghani MG and McLoud TC. Tuberculosis from head to toe. Radiographics. (2000)