Presentation
Visitor to Australia, soft tissue foreign body?
Patient Data
There is extensive soft tissue swelling noted at the proximal interphalangeal joint.
There is no opaque foreign body present.
The proximal and distal phalanges are abnormal, there is a lytic process involving the distal portion to the proximal phalanx, the body of the middle phalanx is destroyed, there is sparing of the interphalangeal joints.
The most likely diagnosis is either infiltration with sarcoid or tuberculous dactylitis.
A pyogenic infection is less likely.
Case Discussion
Ultrasound guided aspiration revealed TB.
Chest radiographs showed no evidence of pulmonary TB or sarcoidosis.
This case demonstrates features of phalangeal osteitis diaphyseal expansile lesion involving both the proximal and middle phalanges.
The differential diagnosis is made among:
- tuberculous dactylitis, also known as spina ventosa
- sarcoidosis
- pyogenic or fungal infections
- syphilitic dactylitis
- sarcoidosis
- hemoglobinopathies
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