Presentation
Two weeks of painless swelling of the left hand. No history of trauma.
Patient Data
Sclerosis with periosteal reaction of the 2nd metacarpal. Associated marked soft tissue swelling. No joint destruction.
Diffuse marrow infiltration of the second metacarpal with cortical destruction and periosteal reaction. There is an intraosseous abscess with adjacent peripherally enhancing collection.
Large left-sided pleural effusion with compressive collapse of the left lower lobe. Nodule noted within the right upper zone.
Left lower lobe compressive collapse/consolidation in addition to segmental left upper lobe collapse/consolidation. This is on a background of innumerable sub-5 mm bilateral pulmonary nodules predominantly in the upper lobes. No cavitation or calcification. Large left pleural effusion. Enlarged mediastinal lymph nodes.
The patient underwent left pleural tap and pleural biopsy with a weakly positive pleural fluid PCR for tuberculosis. The hand was not aspirated/biopsied in the view of these results and the patient was commenced treatment for tuberculosis (also in the context of emigrating from a TB-endemic country three years earlier).
Case Discussion
Spina ventosa is another name given to tuberculous dactylitis, and is a relatively uncommon manifestation of tuberculosis.
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