:: 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.[1] The word is derived from Latin (Spina-'a thorn'; ventosa-'full of wind, distended').[2] 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.