31 Dactylitis*

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig B 31-1 Hand-foot syndrome in sickle cell anemia. Diffuse destruction of the shafts of multiple phalanges and metacarpals is due to infarction. There are reactive bone changes with sclerosis and periosteal thickening.

• Fig B 31-2 Tuberculosis. Typical expansion of a phalanx along with irregular destruction of bone architecture. Note the absence of periosteal reaction, which differentiates the appearance from that of syphilitic dactylitis.38

• Fig B 31-3 Yaws. Examples of cortical and medullary granulomas along with intense periosteal new bone formation.10

• Fig B 31-4 Congenital syphilis. Typical destructive expansion of a phalanx with periosteal calcification forming a dense shell around the lesion.

• Fig B 31-5 Sarcoidosis. Destructive changes involving the middle phalanx of the second finger, with soft-tissue swelling about the third proximal interphalangeal joint and cortical thinning and a lacelike trabecular pattern affecting the proximal phalanges of the third and fourth digits.

• Fig B 31-6 Tuberous sclerosis. Cyst-like expansion and characteristic wavy periosteal new bone formation about the proximal and middle phalanges of the second digit. Periosteal new bone formation is also seen along the shaft of the second metacarpal.