|SPOT THE DIAGNOSIS
|Year : 2006 | Volume
| Issue : 4 | Page : 314
Fusiform swellings of fingers in a 3-year-old girl
AK Roy1, S Khanduri2, KM Girisha3
1 Department of Surgery, Era's Lucknow Medical College, Lucknow, India
2 Department of Radiodiagnosis, Era's Lucknow Medical College, Lucknow, India
3 Department of Pediatrics, Era's Lucknow Medical College, Lucknow, India
K M Girisha
Department of Pediatrics, Era's Lucknow Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy A K, Khanduri S, Girisha K M. Fusiform swellings of fingers in a 3-year-old girl. J Postgrad Med 2006;52:314
A three-year-old girl presented with complaints of low-grade fever and progressive fusiform swellings of fingers for the past six months. She also had similar swellings in the toes and first metatarsal region in both the feet for three-four months. Her complaints had not responded to parenteral antibiotic therapy. The swellings were red in color but were relatively painless. The affected hand and the radiograph are shown in [Figure - 1]. Additional findings on physical examination, chest radiograph and skin test confirmed the diagnosis. Spot the diagnosis.
| :: Answer: Spina Ventosa|| |
The present child had spina ventosa, the tubercular osteomyelitis of small bones of the hands and feet. Her physical examination revealed the presence of generalized lymphadenopathy including matted cervical lymph nodes, bronchopneumonia and hepatosplenomegaly.
The radiograph of the hands and feet showed multiple osteolytic lesions (middle phalanges of middle and little fingers in the left hand, first metatarsals of both the feet and first and fourth proximal phalanges of the left foot) with minimal periosteal reaction [Figure - 1]
. Chest radiograph showed patchy consolidation in the right upper zone and left lower zone with hilar lymphadenopathy. Mantoux test was positive. These findings confirmed the diagnosis of disseminated tuberculosis with spina ventosa, the tubercular osteomyelitis of small bones. The swellings subsided within six weeks of initiation of anti-tuberculous therapy. The treatment is being continued for a year. Short and bent fingers were the sequels of the lesion.
| :: Discussion|| |
Spina ventosa refers to a form of tuberculous osteomyelitis where underlying bone destruction, overlying periosteal reaction and fusiform expansion of the bone results in cyst-like cavities with diaphyseal expansion.
The word is derived from Latin (Spina-'a thorn'; ventosa-'full of wind, distended').
It typically involves phalanges, metacarpal and metatarsal bones in children. Though tuberculosis is a common disease in India, spina ventosa is a rare manifestation.
The characteristic findings include the slow progression of the disease, minimal pain despite the fusiform swelling, minimal new bone formation. Similar lesions can be encountered with acute osteomyelitis, dactylitis of sickle cell disease, syphilis, hereditary acro-osteolytic conditions, histiocytosis X and bone tumors. However, the classical lesion, associated lymphadenopathy, primary lung lesion, positive mantoux test and response to anti-tubercular therapy confirmed the diagnosis in this case.
| :: References|| |
|1.||Teo HE, Peh WC. Skeletal tuberculosis in children. Pediatr Radiol 2004;34: 853-60. [PUBMED] [FULLTEXT]|
|2.||Weber P, Rosslein R. Rapidly growing tumor of the hand-Is tuberculosis as differential diagnosis gaining increased importance? Handchir Mikrochir Plast Chir 1994;26:91-4. [PUBMED] |
[Figure - 1]
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